Biomedical subjects
N Bowles
Publications and source records attributed to N Bowles.
An evaluative study of clinical supervision based on Proctor's three function interactive model.
This paper reports on a study of the benefits reported from participation in clinical supervision by registered nurses (n=201) working in a large English community and mental health NHS Trust. It summarizes the emergent practical and theoretical 'key ingredients' of clinical supervision in the United Kingdom and argues that these provide a basis for generalizable research practice. The study is based on Proctor's three function interactive model previously commended as a guide for supervisory practice and evaluation. Within this study, the three functions underpin instrument design but are also a primary focus of evaluation. The development of this instrument through semi- structured interviews with supervisors and supervisees is described. The study aims to assess and compare reported benefits in each of the three functions of accountability, skill development and support in order to examine the effects of contract use, length of experience of clinical supervision and length of service as a registered nurse on reported benefits by using non-parametric statistical analysis. The results indicate that reported benefits are experienced in almost equal proportion across each of these three functions. Statistical analysis indicates a significant positive correlation between experience of clinical supervision and its reported benefits. An inverse correlation is reported between length of service and overall benefits; however, no similar reduction over time against normative benefits was found. There was no relationship between contract use and reported benefits. Limitations of the study are discussed with reference to bias, interview transcription and overlap between the three functions. The paper concludes that nurses report clear benefits from clinical supervision in each of the three functions. This validates the three function interactive model and demonstrates that clinical supervision is used to critically examine and change nursing practice. The content and usage of contracts is identified as an aspect that merits further study.
Partnerships for sound practice.
Our research into clinical supervision is continuing and project members are disseminating clinical supervision throughout the organisation. Evaluation clearly shows that at least 25% of registered nurses are already engaged in clinical supervision. There are no distinct clinical areas that have not supported staff members participating in the project, indicating its widespread acceptance. In addition, we have discovered that staff with the least prior experience of clinical supervision, such as school nurses and health visitors, are committed to its practice. Clinical supervision is no longer seen as the preserve of mental health nurses. The project is enhancing relationships at all levels between nurses. Service development and rigorous research have been closely linked, while, for individual nurses, continuing professional development is offering a pathway to academic qualification.
Retrovirus-mediated in vivo gene transfer in the replicating liver using recombinant hepatocyte growth factor without liver injury or partial hepatectomy.
Retrovirus-mediated gene delivery into hepatocytes in vivo provides long-term gene expression, which is of great importance for treating most genetic and metabolic disorders. However, clinical application has not been realized because of the requirement for prior 70% partial hepatectomy or chemical (toxic) liver injury to initiate hepatocyte replication at the time of retroviral gene transduction. In this paper, we describe a novel gene delivery system that uses recombinant hepatocyte growth factor (rHGF) prior to retrovirus-mediated in vivo gene transfer in the liver without partial hepatectomy or liver injury. A single retroviral infusion through the portal vein following five systemic injections (via the tail vein) of 100 microg/kg rHGF resulted in a 10.4% 5-bromo-2'-deoxyuridine (BrdU) labeling index (BLI) and 0.14% retroviral gene transduction efficiency (RGTE) in hepatocytes, which were 6.3- and 12.9-fold higher than those of controls, respectively. Modest additional increases in BLI and RGTE (13.4% and 0.22%, respectively) were seen after five systemic injections of 500 microg/kg rHGF. The correlation between BLI and RGTE was statistically confirmed regardless of treatment. When rats received multiple retroviral infusions through a cannulated portal vein following five portal injections of 100 microg/kg rHGF, RGTE was dramatically increased (1.3%) and in some areas of the liver exceeded more than 10%. There was no evidence of liver injury in any animal. This approach has great potential for clinical application in terms of avoiding invasive procedures or liver injury.
Detection of intrauterine viral infection using the polymerase chain reaction.
Intrauterine viral infection commonly presents as nonimmune hydrops fetalis or intrauterine growth restriction. Cytomegalovirus (CMV) and parvovirus are commonly recognized causes of fetal infection using serology and cultures. We used the polymerase chain reaction (PCR) to evaluate the frequency of fetal viral infection and the associated clinical course and outcome. Specimens (amniotic fluid, fetal blood, pleural fluid, tissue) from 303 abnormal pregnancies at risk for viral infection and 154 controls were analyzed using primers for CMV, herpes simplex virus, parvovirus B19, adenovirus, enterovirus, Epstein-Barr virus, and respiratory syncytial virus. Viral genome was detected in 144/371 samples (39%) or 124/303 patients (41%), with adenovirus (n = 74 patients; 24%), CMV (n = 30 patients; 10%), and enterovirus (n = 22 patients; 7%) most common. Only 4/154 (2.6%), unaffected control patients' samples were PCR positive. We conclude that diagnosis of fetal viral infection by PCR is common in abnormal pregnancies. Adenovirus and enterovirus may cause fetal infection that have been previously unrecognized.
Intrauterine adenoviral infection associated with fetal non-immune hydrops.
A 27-week fetus with hydrops fetalis associated with fetal tachyarrhythmia and adenovirus infection was documented by viral polymerase chain reaction (PCR). The fetal tachyarrhythmia was converted to normal sinus rhythm by maternal pharmacological therapy with digoxin. Subsequently, resolution of the hydropic changes occurred and a viable normal-appearing preterm fetus at 29 weeks' gestation was delivered after preterm labour. This case demonstrates the first documented report of intrauterine adenovirus-associated fetal tachyarrhythmia and hydrops fetalis.
Visionary countdown.
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Valuing theatre nursing.
In this paper, the constraints and opportunities for the acquisition of clinical skills within pre-registration education is considered. The impact of limited skills acquisition is discussed with reference to the author's own clinical area, theatres and postoperative recovery. A short and arguably under-valued placement is examined, and a local strategy to promote the usefulness of the theatre placement is offered.
Story telling: a search for meaning within nursing practice.
Story telling has been used for centuries as a powerful vehicle for communication, education, recreation and the preservation of cultural identity. In this paper the appeal of stories is discussed, and placed in a nursing context, with reference to the health care environment, which is increasingly dominated by technology, and the collection of impersonal 'information' against a background of market forces and competition. It is argued that this environment alienates nurses from each other, and from their patients, leaving them emotionally impoverished and distanced from the basic humanity of their craft. The utility of storytelling as a professional development tool is discussed, and numerous examples reviewed, in relation to pre-registration, post registration and ongoing experiential learning situations. The simplicity and immediacy of the storytelling tradition is compared to the academically generated and rhetoric laden notion of 'reflective practice'. The paper concludes that storytelling is an accessible yet powerful tool which contextualises and humanises nursing knowledge, facilitating a deeper understanding of self and others.
Site-directed mutagenesis of the P2 region of the Rous sarcoma virus gag gene: effects on Gag polyprotein processing.
The Pr76Gag and Pr180Gag-Pol polyprotein precursors of Rous sarcoma virus contain a 22-amino-acid spacer peptide, called p2, located between the amino acid sequences of the mature Gag proteins MA and p10. This spacer peptide is present in stoichiometric amounts in the virion, albeit cleaved into two parts, but its function is unknown. The primary sequence of this peptide includes a region that is highly conserved among retroviruses, consisting of four prolines followed by tyrosine. We have investigated the role of p2, particularly the polyproline motif, in the virus life cycle by site-directed mutagenesis. Mutations in this region result in the intracellular accumulation of a truncated Gag precursor, due either to a block in the intracellular processing of the precursor or to the premature activation of the viral protease. Since in cells infected by Rous Sarcoma Virus there is no significant intracellular processing of the Gag polyprotein precursor, our data suggest that the p2 domain plays a role in controlling the activation of the protease. These mutations also result in a reduction in virus particle release, probably as a direct consequence of the aberrant precursor processing since a construct in with both p2 and the protease active site were mutated did not exhibit aberrant processing of the Gag polyproteins and formed particles with an efficiency similar to that of the wild type. This indicates that it is the viral protease that is responsible for the aberrant processing and suggests that the p2 region is not required for assembly. Although the virus genomic RNA packaged into virions produced by the p2 mutants is more susceptible to degradation, it appears that the p2 domain does not have a direct role in RNA packaging and protection.
Complementation studies with Rous sarcoma virus gag and gag-pol polyprotein mutants.
Avian retroviruses (with the notable exception of spleen necrosis virus) express their protease (PR) both in their gag and their gag-pol polyprotein precursors, in contrast to other retroviruses, notably, the mammalian retroviruses, in which PR is encoded in the gag-pol polyprotein or in a separate reading frame as a gag-pro product. The consequence is that the avian PR is expressed in stoichiometric rather than catalytic amounts. To investigate the significance of the particular genome organization of the avian retrovirus prototype Rous sarcoma virus, we developed an assay that measures complementation between the gag and the gag-pol polyproteins by expressing them from two different plasmids in transfected cells. By using this assay, we showed that the protease PR from the gag-pol polyprotein is capable of autocatalytic self-cleavage and -activation when coexpressed with a protease-deficient gag protein and that the PR domain has a role in viral particle assembly. Furthermore, this complementation assay can be used to investigate the role of the gag domain in the gag-pol polyprotein by determining whether it can rescue a defect in the gag polyprotein. We report here the results of such an experiment, which studied a mutation in the N terminus of the gag gene.
Born to be wired.
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Methods of nurse selection: a review.
The trauma and horror of the Beverley Allitt case, and others, have forced the issue of selection of prospective nurses back to the top of the agenda. In this article, the author criticises current selection procedures, then outlines some of the various psychological and intelligence tests which could, he claims, make selection a more objective and reliable process.
A critical appraisal of preceptorship.
Preceptorship is a concept which has been wholeheartedly endorsed by the UKCC. On the evidence of a proliferating body of literature on the subject, it also has wider approbation. This article questions the foundation of the UKCC's concept of preceptorship and examines the implications for nurses of uncritical acceptance of five assumptions, perceived by the author to be inherent in the UKCC's definition.
The Delphi technique.
The Delphi survey technique has merit in both qualitative and quantitative research, but fewer researchers are using it. This article reviews the Delphi technique and its use in nursing, medical and allied health literature between 1981 and 1998. The strengths and weaknesses of the technique are discussed.