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PubMedDate not supplied

Using facilitators in mock codes: recasting the parts for success.

BACKGROUND: Members of the CHRISTUS Santa Rosa Children's Hospital staff development committee identified a need for a mock code program which would address a range of learning needs for nurses and other caregivers with varying levels of knowledge, skills, and experience. METHOD: We implemented a mock code program using experienced caregivers, usually emergency room and pediatric intensive care RNs and respiratory therapists to serve as facilitators to code participants during the mock code drills. Facilitators have dual roles of teaching and guiding the code participant as well as evaluating performance. RESULTS: Code participants and facilitators benefit from the design of this program. Debriefing session input and written program evaluations show that code participants value the opportunity to practice their skills in a nonthreatening situation in which they receive immediate feedback as needed. Facilitators learn to teach and coach and strengthen their own code knowledge and skills at the same time. CONCLUSION: This mock code program serves as a unique way to include novice and experienced nurses in mock codes together. The knowledge, skills, and confidence of the code participants and the facilitators have matured. The design of the program allows for immediate teaching/learning where needed, as well as appropriate evaluation. This program develops stronger, calmer, more efficient, and more confident nurses during codes. Practice and equipment changes can be based on findings from the mock codes. The program is invaluable to patients, staff, and hospital.

Cardiopulmonary Resuscitation↗
PubMed1981

[Cell membrane characteristics and biological behavior of virus transformed cells (author's transl)].

The transformation of a normal into a tumor cell is not caused by a single molecular event, but is the consequence of several simultaneous or consecutive molecular processes, which lead to a variety of changes in the structure and the metabolism of the cell. Investigations with the Rous sarcoma virus show that a single gene is primarily responsible for these changes that is coding for a phosphoprotein which, however, is multifunctional. The biochemical and biologic events which initiate and maintain the transformed status of the cell involve mainly the cytoplasma membrane. At both the outer and the inner surface of the cell membrane dramatic changes occur which influence the cell structure, permeability of the cytoplasma membrane, and the intracellular metabolic pathways. Most probably, these transformation-associated events are also involved in cell proliferation under physiologic conditions. In the tumor cell, however, they are not further regulated physiologically, with the consequence of an uncontrolled and incessant cell division.

Animals↗
PubMedDate not supplied

Phase II evaluation of clinical coding schemes: completeness, taxonomy, mapping, definitions, and clarity. CPRI Work Group on Codes and Structures.

OBJECTIVE: To compare three potential sources of controlled clinical terminology (READ codes version 3.1, SNOMED International, and Unified Medical Language System (UMLS) version 1.6) relative to attributes of completeness, clinical taxonomy, administrative mapping, term definitions and clarity (duplicate coding rate). METHODS: The authors assembled 1929 source concept records from a variety of clinical information taken from four medical centers across the United States. The source data included medical as well as ample nursing terminology. The source records were coded in each scheme by an investigator and checked by the coding scheme owner. The codings were then scored by an independent panel of clinicians for acceptability. Codes were checked for definitions provided with the scheme. Codes for a random sample of source records were analyzed by an investigator for "parent" and "child" codes within the scheme. Parent and child pairs were scored by an independent panel of medical informatics specialists for clinical acceptability. Administrative and billing code mapping from the published scheme were reviewed for all coded records and analyzed by independent reviewers for accuracy. The investigator for each scheme exhaustively searched a sample of coded records for duplications. RESULTS: SNOMED was judged to be significantly more complete in coding the source material than the other schemes (SNOMED* 70%; READ 57%; UMLS 50%; *p < .00001). SNOMED also had a richer clinical taxonomy judged by the number of acceptable first-degree relatives per coded concept (SNOMED* 4.56, UMLS 3.17; READ 2.14, *p < .005). Only the UMLS provided any definitions; these were found for 49% of records which had a coding assignment. READ and UMLS had better administrative mappings (composite score: READ* 40.6%; UMLS* 36.1%; SNOMED 20.7%, *p < .00001), and SNOMED had substantially more duplications of coding assignments (duplication rate: READ 0%; UMLS 4.2%; SNOMED* 13.9%, *p < .004) associated with a loss of clarity. CONCLUSION: No major terminology source can lay claim to being the ideal resource for a computer-based patient record. However, based upon this analysis of releases for April 1995, SNOMED International is considerably more complete, has a compositional nature and a richer taxonomy. Is suffers from less clarity, resulting from a lack of syntax and evolutionary changes in its coding scheme. READ has greater clarity and better mapping to administrative schemes (ICD-10 and OPCS-4), is rapidly changing and is less complete. UMLS is a rich lexical resource, with mappings to many source vocabularies. It provides definitions for many of its terms. However, due to the varying granularities and purposes of its source schemes, it has limitations for representation of clinical concepts within a computer-based patient record.

Abstracting and Indexing↗
PubMed1989

Mapping of attenuating sequences of an avirulent poliovirus type 2 strain.

A mouse model for poliomyelitis was used to identify genomic sequences that attenuate neurovirulence of poliovirus strain P2/P712. This type 2 strain is avirulent in primates and mice yet grows as well as virulent strains in cell culture. The approach used was to exchange portions of the genome of the mouse-virulent P2/Lansing strain with the corresponding region from P2/P712 to identify sequences that could attenuate Lansing neurovirulence in mice. A full-length infectious cDNA of P2/P712 was assembled and used to construct recombinants between P2/P712 and P2/Lansing. The results of neurovirulence testing of 11 recombinants indicated that strong attenuating determinants are located in the 5' noncoding region of P2/P712 and a region encoding capsid protein VP1 and 2Apro, 2B, and part of 2C. An attenuating determinant was further localized to between nucleotides 456 and 628 of P2/P712. A third sequence from P2/P712, nucleotides 752 to 2268, encoding VP4, VP2, and part of VP3, was weakly attenuating. The sequence from nucleotide 4454, approximately halfway through the 2C-coding region, to the end of the P2/P712 genome did not contain attenuating determinants. Nucleotide sequence analysis revealed that P2/P712 differs from the type 2 Sabin vaccine strain by only 22 nucleotides. Six differences lead to amino acid changes in the coding region, and four differences are in the 5' noncoding region. These studies show that, like the type 1 and type 3 Sabin vaccine strains, the attenuated type 2 strain P712 contains multiple attenuating sequences, including strongly attenuating sequences in the 5' noncoding region of the genome.

Animals↗
PubMed2002

Stabilization of ablative Rayleigh-Taylor instability due to change of the Atwood number.

Recent experiment [S.G. Glendinning et al., Phys. Rev. Lett. 78, 3318 (1997)] showed that the measured growth rate of laser ablative Rayleigh-Taylor (RT) instability with preheating is about 50% of the classic value and is reduced by about 18% compared with the simulated value obtained with the computer code LASNEX. By changing the temperature variation of the electron thermal conductivity at low temperatures, the density profile from the Bhatnagar-Gross-Krook approximation is recovered in the simulation, and the simulated RT growth rate is in good agreement with the experimental value from Glendinning et al. The preheated density profile on ablative RT stablization is studied numerically. A change of the Atwood number in the preheating case also leads to RT stabilization. The RT growth formula gamma=square root of [Akg/(1+AkL)] - 2kV(a) agrees well with experiment and simulation, and is appropriate for the preheating case.

Journal Article↗
PubMed1997

Delimitation of a critical tumour suppressor region at distal 1p in neuroblastoma tumours.

We analysed DNA from 68 neuroblastoma tumours for loss of heterozygosity (LOH) on the distal chromosome 1p (1p-LOH) using PCR-based DNA polymorphisms. Fifteen tumours (22%) displayed 1p-LOH. The shortest region of overlap (SRO) for the deletions was defined proximally by marker D1S244 and distally by marker D1S80. The CDC2L1 locus, located on chromosome 1p36, has been put forward as a neuroblastoma tumour suppressor. We analysed coding regions of the CDC2L1 gene in a subset of aggressive neuroblastoma tumours with known allelic loss for different 1p-markers. Single-stranded conformation polymorphism, heteroduplex and sequencing analysis of tumour DNA did not reveal any significant changes in the coding region. Using a DNA sequence polymorphism, we showed, in a primary tumour with an interstitial allelic deletion, that this tumour had both alleles of the CDC2L1 locus retained in the tumour. Thus, we showed that the neuroblastoma tumour suppressor critical region on 1p in our material is defined by loci D1S244 and D1S80 and that the CDC2L1 locus is distal to the critical region.

Child↗
PubMed1988

cDNA cloning and sequence of a new type of actin in mouse B16 melanoma.

Parent B16 melanoma and B16-F1 cell lines express a third actin (Ax) in addition to beta- and gamma-actin. It has the same molecular mass (43,000 daltons) and a more acidic isoelectric point (pI = 5.2) than the latter two actins (pI = 5.3) (Taniguchi, S., Kawano, T., Kakunaga, T., and Baba, T. (1986) J. Biol. Chem. 261, 6100-6106). We constructed a cDNA library from poly(A)+ RNA of B16-F1 and then isolated Ax actin candidate clones. According to the nucleotide sequencing analysis for one of the candidate clones, pMA 30, the predicted amino acid sequence was composed of 375 amino acids and was similar to that of beta-actin, but differed at the 28th amino acid in that leucine replaced the arginine of beta-actin. When RNA synthesized from the clone pMA 30 with the SP6 transcription system was translated in vitro using reticulocyte lysate, we identified a polypeptide which had the same isoelectric point and molecular weight as Ax actin; the polypeptide had binding activity to DNase I, a common characteristic of native actin. These observations provide evidence that the clone pMA 30 encodes the mRNA for Ax actin. In the nucleotide sequence of the Ax cDNA, there are: 1) one base change in the coding region which causes a loss of the SmaI site and an amino acid exchange, as mentioned above; 2) four deletion sites in the 3'-noncoding region; 3) one insertion site in the 3'-noncoding region; and 4) one base change in the 5'-noncoding region, as compared with hitherto known mouse beta-actin cDNA. These differences between Ax and beta-actin cDNA indicate that the Ax actin is encoded by an unique gene set, independent of beta-actin.

Actins↗
PubMed1992

Pyrimethamine resistant mutations in Plasmodium falciparum.

Three mutations in Plasmodium falciparum yielding increased resistance to pyrimethamine were obtained following treatment with chemical mutagens and selection in presence of pyrimethamine. From parasite clone TM4/8.2 a mutant, TM4/8.2/4.1, was produced which raised pyrimethamine resistance about 500 times and was found to involve an amino acid change in the DHFR-TS enzyme molecule from Ser108 to Asn108. A clone of another isolate, T9/94, yielded a mutant, T9/94/300.300, raising pyrimethamine resistance about 10 times and involving an amino acid change from Ile164 to Met164. However, another mutant from T9/94, T9/94/M1-1(b3), although it raised the pyrimethamine resistance 100 times, did not involve any changes in the coding sequence of the DHFR-TS gene, but resulted in the production of about twice as much DHFR-TS enzyme as the original clone T9/94. No amplification of the DHFR-TS gene was detected. It is concluded that changes in pyrimethamine resistance of malaria parasites may arise in at least 2 ways: (1) by structural changes in the DHFR domain of the DHFR-TS gene (as previously found by other workers); (2) by other changes, possibly affecting the expression of the DHFR-TS gene. The relative importance of these 2 mechanisms in causing resistance in wild populations of P. falciparum is discussed.

Animals↗
PubMed1985

Hemophilia A. Detection of molecular defects and of carriers by DNA analysis.

To understand the molecular basis of hemophilia A and to provide heterozygote detection and prenatal diagnosis by DNA analysis, we used cloned factor VIII:C DNA fragments to study 10 affected families. In four of these families, inhibitors of factor VIII:C had developed in affected persons. In one such family a deletion of approximately 80 kb within the factor VIII:C gene was identified. Carriers of the deletion were identified through detection of an abnormal DNA fragment located at the deletion end points. In another family a single nucleotide change in the coding region of the factor VIII:C gene produced a nonsense codon leading to premature termination of factor VIII:C synthesis. Carrier detection was performed in eight female members of this four-generation family. In a third family a small change in the size of a restriction-endonuclease fragment correlated with the presence of the mutant gene, and in the other seven families the molecular defect has not yet been identified. In addition, we used two common polymorphic sites in the factor VIII:C gene to differentiate the normal from the defective gene in four of six obligate female carriers from families with patients in whom inhibitors did not develop. Carrier detection was possible in other members of these families. These data suggest that DNA analysis of the factor VIII:C gene provides an accurate method of carrier detection and, potentially, of prenatal diagnosis in at least 50 per cent of the pedigrees affected by hemophilia A.

Chromosome Deletion↗
PubMed2000

Changes in tactile spatial discrimination and cutaneous coding properties by skin hydration in the elderly.

Neurosensory tactile functions were investigated in human subjects by two different and complementary experimental approaches. First, a conventional psychophysical method (two-point gap discrimination) was used to determine the tactile discrimination threshold by analyzing the subjects' ability to detect a gap of variable width between two contact points when a series of stimuli was applied to the skin. Using this method we confirmed the marked degradation of tactile spatial acuity with age and showed that skin discriminative function was partially restored after hydration of the skin with a moisturizer. The second approach consisted of a microneurographic recording of tactile afferent fibers in response to two types of mechanical stimuli applied reproducibly to the corresponding receptive fields. With this method, we found that the afferent messages were depressed following hydration of the skin surface. Thus, partial restoration of tactile spatial acuity after hydration appears to be due to both a softening of the stratum corneum permitting better localization of the stimulus and a weaker transfer of the stimulus toward the sensory receptors.

Adult↗
PubMed1997

A hospital pioneers reform of its state's procurement code.

In today's changing healthcare marketplace, hospitals across the US are rapidly moving toward developing integrated healthcare delivery networks. In addition, the emergence of managed care and the growing trend toward capitation have compelled hospitals to reduce costs in response to these changes. Moreover, this impetus to provide quality care at reduced cost has affected the purchasing behavior of many hospitals, forcing material managers to pursue innovative procurement methods. This article describes how the Medical University of South Carolina (MUSC) Medical Center, (Charleston, SC) obtained significant savings in purchasing as a result of pioneering legislative reforms in the procurement process.

Competitive Bidding↗
PubMed1984

[Changes in the content of matrix RNA coding tyrosine aminotransferase in the rat liver during hydrocortisone induction].

The effects of the glucocorticoid hydrocortisone on the synthesis of specific template RNA coding tyrosine aminotransferase (TAT) in rat liver during hormonal induction were studied. Using hybridization of complementary DNA (cDNA-TAT) with polysomal liver poly-A-mRNA, the content of specific mRNA-TAT in liver polysomes during and after hormonal induction, i. e. 4 and 16 hrs after hydrocortisone injection, respectively, was estimated. It was shown that 4 hrs after the hormone injection that mRNA-TAT content in liver polysomes is increased 3-4-fold, showing a return to the initial level after 16 hrs. Thus, transcription is the main link in the realization of glucocorticoid induction.

Animals↗
PubMed2001

Thrombomodulin promoter mutations, venous thrombosis, and varicose veins.

We analyzed the distal promoter region of the thrombomodulin (TM) gene (nucleotides -300 to -2052) in subjects from the Paris Thrombosis Study (PATHROS), a French case-control study of venous thrombosis, to identify polymorphisms that might modify TM gene expression. Eight novel mutations were found in the 40 DNA samples initially screened. Two of these mutations (-1748G/C and -1208/-1209 del TT) were frequent. One rare transition (-1166G/A) might have functional consequences owing to its position. These 3 mutations were screened for in the entire study population of 327 patients and 398 controls. None of the 3 was significantly associated with thrombosis. Interestingly, the -1208/-1209 TT deletion was associated with varicose veins in the patients. This mutation was in tight linkage disequilibrium with the +1418 C/T change in the coding sequence, a known polymorphism that predicts an Ala 455 Val substitution in the sixth epidermal growth factor-like TM module, a domain previously implicated in the proliferative functions of TM. This linkage suggests that the Ala 455 Val mutation may promote changes in these functions and thus be involved in varicose vein formation.

Adult↗
PubMed1995

Alterations in the structure of the EBV nuclear antigen, EBNA1, in epithelial cell tumours.

The EBV nuclear antigen, EBNA1, is the only viral protein consistently expressed in all virus-infected cells. It is required in trans for viral replication, maintenance of EBV extrachromosomal episomes, and transcriptional transactivation in latently-infected B-cells. It binds RNA suggestive of a regulatory role in post-transcriptional events and in transgenic mice, it is tumorigenic. In RNase protection studies relating to the EBV-associated tumour, nasopharyngeal carcinoma (NPC), we show that a C-terminal EBNA1 RNA probe from the prototype B95-8 marmoset strain can protect its own mRNA from enzymatic digestion, but does not fully protect EBNA1 mRNA from NPC cells. This finding is consistent with changes in the coding region for the antigen. We thus determined the sequences of EBNA1 genes derived from an NPC xenograft and numerous patient biopsies and identified a number of mutations in the gene in these human cells, relative to B95-8. Many of the nucleotide changes would lead to non-conservative amino acid alterations in apparently functionally significant regions of the protein. We show that although some of the mutations lie in regions designated as critical to DNA binding, they have negligible effect on this property of EBNA1. The basic regions in EBNA1 that may bind to RNA, at least in vitro, are exempt from mutation. Thus, unless the alterations are 'silent', which for such a critical viral function seems unlikely, they may relate to as yet unmapped viral activities, such as a role in tumorigenesis and the ability of EBNA1 to evade the cellular immune system, or be associated with the ability of the antigen to regulate gene transcription.

Amino Acid Sequence↗