The role of the nurse manager in ensuring competence -- the use of portfolios and reflective writing.
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Clinical Competence↗
Biomedical subjects
M Jasper
Publications and source records attributed to M Jasper.
Leptin and leptin receptor are expressed in the human endometrium and endometrial leptin secretion is regulated by the human blastocyst.
Embryonic implantation is a crucial event for the human reproductive function. Cytokines and paracrine molecules have been proposed as putative local regulators of this process. The leptin or the OB protein has been linked to the reproductive function and inflammatory response. In the present study, we describe for the first time the expression of leptin and leptin receptor (long form) in the secretory endometrium and that endometrial leptin secretion is regulated in vitro by the human blastocyst. Leptin and leptin receptor messenger RNA and protein were identified in secretory endometrium and in cultured endometrial epithelial cells (EECs) by RT-PCR, Western blot, and immunohistochemistry. The concentrations of immunoreactive leptin secreted by human embryos alone or cocultured with EECs were also assessed. We found that human blastocysts secrete significantly higher levels of leptin than arrested embryos. In contrast, leptin concentrations secreted by arrested embryos cocultured with EECs were significantly higher than blastocysts cocultured with EECs. These findings suggest that the human endometrium is a site for local production and a target tissue for circulating leptin. Expression of leptin and its functional receptor in the endometrium and regulation of endometrial leptin secretion by the human embryo suggests that the leptin system may be implicated in the human implantation process.
Adult↗
Developing the role of the generic healthcare support worker: phase 1 of an action research study.
This paper reports on the first phase of an action research practice development project to explore, develop and evaluate the role of the generic healthcare support worker in a high dependency rehabilitation service. The project is being jointly conducted by staff from the University of Southampton, the University of Portsmouth and the Isle of Wight Healthcare NHS Trust and phase 1 is supported by a grant from the NHS Executive (South and West). The aim of phase 1 of the project is to explore the attitudes of staff towards the implementation of the role of the generic healthcare support worker, particularly regarding the practical, professional and ethico-legal problems of the role. Professional and support staff from different parts of the service were interviewed in groups and the interviews were tape recorded, transcribed and subjected to a simple thematic analysis. Four themes emerged from the data relating to the challenge to professional boundaries, being a generic worker, outcomes for service and patients and implementing the role. As an action research project, the aim was not to produce findings that are generalizable beyond the practice areas in which they were generated, but it is nevertheless hoped that the reader might be able to apply some of the conclusions to his or her own setting.
Attitude of Health Personnel↗
Variations in peripheral blood levels of immunoreactive tumor necrosis factor alpha (TNFalpha) throughout the menstrual cycle and secretion of TNFalpha from the human corpus luteum.
OBJECTIVE: Several cytokines have been implicated as important mediators in the cyclic processes occurring in the reproductive organs. In the present study the peripheral blood concentrations of the cytokines interleukin(IL)-2, IL-6, and tumor necrosis factor (TNF) alpha, as well as the secretion of TNFalpha from the human corpus luteum were investigated. STUDY DESIGN: The study was undertaken at infertility clinics at large teaching hospitals. Eight women with unexplained infertility undergoing investigations with measurements of endocrine profiles throughout a cycle prior to IVF treatment were included in the study of blood concentrations of cytokines. Blood plasma were taken daily or every second day from a time 3-4 days before expected LH peak until menstruation. The levels of immunoreactive IL-2, IL-6 and TNFalpha were measured by ELISA technique and evaluated (repeated measures ANOVA and Scheffes test) in relation to levels on the day of the LH surge. To investigate a possible ovarian source of TNFalpha, corpus luteum (CL) tissue and cells obtained during the luteal phase from another group of women during abdominal surgery for benign uterine diseases, were cultured for 24 h to assess (ANOVA and Bonferroni test) the release of TNFalpha. RESULTS: There were no significant fluctuations in the levels of IL-2 and IL-6 throughout the menstrual cycle. The concentration of TNFalpha showed significant fluctuations over the menstrual cycle. Compared to the values on the day of the LH surge, the concentrations were significantly increased during the late follicular phase and during the mid luteal phase. In the early luteal phase the levels were significantly decreased. Measurable levels of TNFalpha were found in the conditioned media from one out of three CL obtained from the early luteal phase, and in all media from CL obtained from mid- and late-luteal phases. Luteal cells in culture secreted TNFalpha, and the levels in the media were not influenced by the presence of hCG (100 IU/L). The conditioned media of luteal cells from late luteal phase contained higher levels than media of cells from early luteal phase, with the levels being higher in media of a mixture of all luteal cells, and large luteal cells as compared to small luteal cells. CONCLUSION: This study demonstrates that there are marked fluctuations of blood levels of TNFalpha during the menstrual cycle and that the human CL secretes TNFalpha, with indications of higher secretion during late luteal phase as compared to early luteal phase.
Adult↗
Ovarian stimulation and endometrial receptivity.
Endometrial receptivity is a limiting step in the success of in-vitro fertilization (IVF). To investigate this issue, we selected a specific population of high responder patients in whom implantation was impaired, even when good quality embryos were transferred. We present a series of studies showing that high oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration are detrimental to uterine receptivity. In addition, we suggest clinical strategies to improve endometrial receptivity in high responder patients using a step-down regimen.
Chorionic Gonadotropin↗
The first year as a staff nurse: the experiences of a first cohort of Project 2000 nurses in a demonstration district.
This paper describes the experiences of eight staff nurses who were students in the first cohort of a Project 2000 course in a pilot district during their post-qualification year. A qualitative approach, informed by phenomenological methodology, was adopted in order to present these experiences alongside the meaning attributed to them by the nurses. Taped, focused group discussions, using semi-structured interviews, were analysed. This yielded five themes which describe the structure of these experiences from "coming out of school' through to the acknowledgement and confidence in themselves as a different kind of nurse to those trained on previous traditional courses. The findings suggest that the vision of the United Kingdom Central Council in proposing Project 2000 courses is likely to be realized. These nurses had gained the competent technical and clinical skills expected of any nurse. However, they also displayed skills previously absent in newly-qualified nurses, such as evidence of analytical decision-making and confident interpersonal skills, which are likely to enable them to take an equal place amongst other members of the multi-professional team in the future. Although competent practitioners, the process they had undergone to reach this had, at times, been traumatic. The implications arising from the study are that more attention needs to be paid to the personal and professional development needs of Project 2000 nurses, both at the end of the course and in their first post-qualifying year.
Adaptation, Psychological↗
Inhibition of nitric oxide: effects on interleukin-1 beta-enhanced ovulation rate, steroid hormones, and ovarian leukocyte distribution at ovulation in the rat.
The ovulatory process resembles an inflammatory reaction with an infiltration of leukocytes, production of inflammatory mediators such as cytokines, and a general edema and hyperemia. Nitric oxide (NO), a potent vasodilator and the main mediator of macrophage tumoricidal and bacteriocidal activities, is known to participate in inflammatory reactions and has been shown to mediate the interleukin-1 beta (IL-1 beta)-directed tissue-remodeling events within the ovary. The regulation by NO of ovulation rate, leukocyte distribution, and steroid release in the rat ovary was investigated through use of a combination of in vivo and in vitro models of ovulation and a competitive inhibitor, N-omega-nitro-L-arginine methyl ester (L-NAME), of the NO synthase (NOS) enzyme. Subcutaneous L-NAME (1.5 x 10(-4) mol/kg) administration significantly reduced the in vivo ovulation rate of eCG/hCG-primed rats (L-NAME-treated: 10.6 +/- 1.8 [mean +/- SEM] oocytes per ovary [O/O], 11.0 +/- 1.2 rupture sites per ovary [RS/O]; saline-treated: 18.0 +/- 1.8 O/O, 19.4 +/- 1.1 RS/O; p < 0.01) at 20 h post-hCG. These results were reflected in vitro, where addition of L-NAME (3.5 x 10(-5) mol/L) to LH (0.1 microgram/ml)-perfused ovaries decreased ovulation rate from 8.2 +/- 1.6 to 2.7 +/- 1 ovulations per ovary (p < 0.05) and simultaneously decreased nitrite accumulation at the completion of perfusions from 16.5 +/- 1.9 to 4.1 +/- 0.5 nmol/ml (p < 0.001). The addition of L-NAME to LH+IL-1 beta (4 ng/ml)-perfused ovaries decreased ovulation rate from 15.2 +/- 2.4 to 0.8 +/- 0.8 ovulations per ovary (p < 0.001) and simultaneously decreased nitrite accumulation at 22 h from 22.8 +/- 2.2 to 1.9 +/- 0.6 nmol/ml (p < 0.001). Studies analyzing and manipulating perfusion flow rate indicated that the L-NAME effects on ovulation rate are primarily due to a reduction in flow rate resulting from inhibition of NO, which may be a consequence of the known vasoconstrictor effects of NOS inhibitors. The observed reduction of in vivo ovulation rate by NO inhibition at 20 h post-hCG was associated with a significant reduction in thecal MCA149+ neutrophils at 12 h post-hCG, the expected time of ovulation (L-NAME-treated: 98.4 +/- 9.2 cells per thecal area; saline-treated: 211.5 +/- 11.5 cells per thecal area; p < 0.001), while ED1+ monocytes/macrophages underwent similar but nonsignificant changes. Plasma (20 h post-hCG) and perfusate progesterone were not different with L-NAME treatment, while perfusate estradiol levels were markedly reduced upon addition of L-NAME, suggesting a role for NO in ovulation but not in the process of luteinization. In summary, deprivation of NO by use of the competitive inhibitor, L-NAME, led to fewer ovulations, reduced accumulation of nitrite, a decreased neutrophil count in the theca of preovulatory follicles, and reduced estradiol secretion, while progesterone release remained unaffected. The NO pathway may therefore play an important role in the regulation of ovulation and the mediation of IL-1 beta's pro-ovulatory effects. There are likely to be primarily vascular effects, but also a nonvascular component, to the NO regulation of ovulation, with both components indirectly affecting ovulatory leukocyte distribution and steroid secretion.
Animals↗
The portfolio workbook as a strategy for student-centred learning.
This paper described the portfolio workbook as a strategy to support student-centred learning in nurse education. The portfolio workbook combines the use of reflection on prior experiences, forward planning to meet identified course outcomes, critical incident analysis and a reflective journal to ensure the integration of theory with practice. This enables the student, rather than the teacher, to control the educative process, and thus develops the skills of autonomy and decision-making envisaged in the development of Project 2000 courses. In using a weekly add-on format, the workbook provides a comprehensive record of the student's learning, whilst at the same time monitoring progress and facilitating the acquisition of knowledge and skills. The use of reflective practice from the beginning of the course, and reinforced throughout, enables the student to internalize the process as a way of identifying and managing their own learning needs. The author concludes that this strategy would be appropriate for all types of nurse learners; however, a precondition for this is an espousal and commitment by teachers to student-centered philosophies and methods of learning.
Education, Nursing, Baccalaureate↗
Immunoactive interleukin-1 beta and tumour necrosis factor-alpha in thecal, stromal and granulosa cell cultures from normal and polycystic ovaries.
Previous studies of follicular fluid from stimulated human ovaries have shown detectable amounts of immunoactive interleukin-1 (IL-1) and tumour necrosis factor-alpha (TNF). Other reports have shown the presence of IL-1 receptors, mRNA and antagonists for IL-1 in the human ovary. The aim of this study was to measure IL-1 and TNF concentrations in follicular fluid from unstimulated normal or polycystic ovaries (PCO) as well as concentrations in media conditioned by granulosa cells or thecal or stromal tissue. TNF concentrations were easily detected in follicular fluid (77 fmol/ml, range 20-95) and concentrations in PCO were similar to those in normal ovaries (70 versus 82 fmol/ml). TNF was virtually undetectable in all tissue culture media. IL-1 concentrations in all culture media were readily detected but showed no differences between different tissues or between PCO and normal ovaries. It was concluded that human ovaries readily produce immunoactive IL-1 in culture but produce less TNF despite detectable amounts of TNF in follicular fluid. There appears to be no difference between PCO and normal ovaries with respect to IL-1 and TNF.
Cells, Cultured↗
A framework for a process-driven common foundation programme for graduates.
This paper discusses some of the problems encountered in writing a shortened Common Foundation Programme in nursing for graduates, and outlines a course which takes as its starting point the particular educational needs and requirements of the student group. Thus, the first question to be addressed by the curriculum writers when designing the course was "How can we teach these students?", rather than "What can we teach them?". The resulting process-driven course is heavily influenced by the student-centred philosophy of Carl Rogers, and utilizes a variety of large- and small-group methods to facilitate the students in gradually taking responsibility for, and making decisions about, their learning needs. The paper continues with some strategies for ensuring a smooth transition from a tutor-led, syllabus-driven start to the course, to a student-led, process-driven finish for both the theoretical and clinical components, and for the assessment schedule. Finally, a student-centred approach to evaluation is briefly outlined, and the paper concludes by suggesting that the principles employed in designing and implementing this course could be successfully transferred to a wide variety of other educational settings.
Curriculum↗
Medical record control and the computer.
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Computers↗
Is a PPO in your future?
A medical group considering the possibility of becoming involved with a PPO faces a host of challenges. The author of this article firmly believes that medical groups today are prime candidates for this emerging alternative delivery system. The evolution and future of PPOs, advantages and disadvantages, and strategies during start-up are presented.
Group Practice↗