Search

Objective To develop an alternative approach to provide oncology pharmacy practice residents’ education and training in the management of gynecologic malignancies in the absence of a specialist in this area at their institution. Setting Gynecologic oncology is a unique specialty in oncology. There is a need for more oncology clinical pharmacy specialists to participate in the care of patients with gynecologic malignancies as many do not have specific education in this area. Practice description A virtual learning experience was developed that included all aspects of a typical experience with the exception of direct patient care. Postgraduate year 2 oncology pharmacy residents from 3 different programs were included. Practice innovation Although the number of oncology clinical pharmacy specialists who are subspecialized in gynecologic oncology has grown, it is difficult to find experienced preceptors in gynecology oncology. We set to offer a virtual learning environment for programs that did not have a dedicated or highly specialized pharmacist in this area. Evaluation A pre- and postlearning assessment of the resident’s knowledge of gynecologic malignancies was administered. Each trainee independently completed a validated 20-question gynecologic oncology knowledge assessment tool before and again after completion of all sessions. Midpoint and end-of-experience evaluations were completed via the phone with each resident. All evaluations were documented in PharmAcademic (McCreadie Group, Ann Arbor, MI), a required software program for postgraduate residency training programs. Results To date, 7 oncology pharmacy practice residents completed the virtual experience. A 42% improvement in scores pertaining to gynecologic oncology knowledge was identified. Residents were also satisfied with the overall virtual experience. Based on the assessment tool, all the residents gave positive evaluations with “always true” for 6 of the 7 questions. Conclusions This pilot of a virtual experience was a successful platform to provide clinical knowledge and skills for oncology pharmacy residents in gynecologic oncology.

A monoclonal antibody (mAb), P4A10, was made to the canine interleukin-2 receptor alpha chain (IL-2Ralpha; p55; Tac antigen; CD25) to facilitate studies of canine regulatory T-cells (Treg). By non-reduced Western blot, P4A10 bound to a 55kDa protein, the size of human IL-2Ralpha. In flow cytometry assays, it reacted with a minor population of circulating dog CD3(+)CD4(+) T-cells and the majority (>60%) of in vitro PMA-Ionomycin (PMA-IO)-activated canine CD3(+) T-cells. P4A10 recognized a hematopoietic cell population enriched for FoxP3+ cells as measured by flow cytometry. The P4A10-selected fractions of T-cells had significantly increased copy numbers of CD25, FoxP3, IL-10, and TGFbeta as detected by RT-PCR (reverse transcriptase-PCR) compared to the negative fractions. The P4A10-selected cells inhibited (3)H (tritiated) thymidine incorporation in a mixed leukocyte reaction (MLR) containing responders of the same origin. P4A10-selected T-cells from fresh peripheral blood mononuclear cells had less FoxP3 (p=0.07) by qRT-PCR (quantitative RT-PCR) and were less suppressive (p=0.01) than in vitro alloantigen-activated Treg. The mAb P4A10 is specific for canine CD25 and can be used to facilitate studies of CD25+FoxP3+ Treg in this clinically relevant large animal model.

Summary This study examined the education of mental health nurses by surveying all qualified mental health nurses working within one National Health Service region in Scotland. Using an adaptation of a previously used instrument, 488 questionnaires were distributed producing a response rate of 194 (39.75%). The study’s themes – initial preparation, professional development and future practice – reveal findings of interest, particularly the axis of RMN (pre-1992 education) and RMN (Project 2000 education). In terms of initial preparation, clear differences between groups were found. Pre-1992 RMNs’ report on educational experience majoring on practical skills contrasts sharply with Project 2000 respondents who, in spite of a course philosophy of reflective practice, emphasised an apparent lack of practical skills for practice. For professional development, both groups valued flexible approaches via journal reading, teaching, networking and participating in clinical supervision. In terms of educational provision, short course provision with an emphasis on short, flexible course provision (e.g., in-service study days), practice education and closer (and flexible) links between higher education and the practice area were highlighted as the most important ways to prepare for future practice.

This paper presents an overview of key findings from an evaluation of a national educational programme that aims to provide healthcare staff with the skills and knowledge necessary to ensure good practice in preventing healthcare associated infections. The research methods comprised literature review, large-scale questionnaire surveys of students and mentors on the Cleanliness Champions Programme, and 20 key-informant interviews. The educational programme was found to be fit for purpose, but there was a need for some restructuring and modifications. Nurses were found to comprise around two-thirds of all registrants on the programme. The study also provided some illumination of initial integration into practice. Cleanliness Champions typically reported substantial impact on their personal practice and many cited examples of influence on colleagues’ practice. However there is an urgent need to ensure that other occupational groups join with nursing by enrolling on the programme in much greater numbers. If this is accompanied by further investment, a critical mass may form that has sufficient multidisciplinary momentum to make good infection prevention and control practices more embedded clinical realities within Scotland. Key lessons from the evaluation are identified that may usefully inform similar initiatives and/or other national healthcare education programmes.

In response to the Dearing Report [Higher education in the learning society. Report of the National Committee of Inquiry into Higher Education. HMSO, London, 1997] modularising courses has been a major activity in schools of nursing and midwifery. This should make it easier for students to transfer between courses, university to university with credit for academic achievement. In respect of mental health nursing students the effect upon opportunities for personal and professional development is considered. The paper questions whether a modular framework of learning experiences meaningfully prepares students for their future as mental health nurses. The continued use of an adapted [A. Beattie, in: P. Allan, M. Jolley (Eds.), The Curriculum in Nurse Education, Croom Helm, London, 1997] fourfold curriculum model in working with students is contrasted with the process of modularisation. Challenges that have arisen for mental health nursing lecturers to continue with this are discussed.

To characterize recombinant human macrophage-colony stimulating factor (rhM-CSF)-associated thrombocytopenia (TCP), in vivo studies were performed in dogs, including the biodistributions and recoveries of radiolabelled autologous and allogeneic platelets. rhM-CSF induced a reversible, dose-dependent decrease in platelet counts. The number of megakaryocytes in spleen and marrow of rhM-CSF-treated dogs was increased two to threefold. Recoveries of allogeneic platelets transfused from rhM-CSF-treated donors into tolerized recipients (n = 3) were not significantly different from allogeneic baseline studies (93 +/- 10% of baseline values at 24 h and 90 +/- 1% at 40 h), whereas autologous platelets infused back into rhM-CSF-treated donors had decreased recoveries (45 +/- 2% of baseline values at 24 h, P = 0.03 and 20 +/- 4% at 40 h, P = 0.001). Platelet biodistribution studies showed increased accumulation of radiolabelled platelets over the spleens and livers of rhM-CSF-treated dogs. Histochemistry showed increased levels of platelet-specific antigen (CD41; glycoprotein IIb) associated with Kupffer cells. The sensitivity of platelets from rhM-CSF-treated dogs to activation from thrombin, as measured by expression of P-selectin (CD62P), was not significantly different when compared with baseline studies (P = 0.18; n = 4). These results support the concept that rhM-CSF induces an activation of the monocyte-macrophage system (MMS), which causes a reversible TCP in a dog model.

The concepts of collaboration and partnership currently have extensive impact upon health care providers and higher education institutions. One of the challenges is to develop networks which will foster partnerships able to react, and contribute, to an ever-evolving educational culture. These themes are illustrated by using the example of one school of nursing and midwifery, and the collective experience of a number of its academic staff. By focusing on distinct features of collaboration (strategic planning, origins of change, group dynamics and building a community), the authors seek to explore the impact of an educational culture in an attempt to provide meaning to their recent experiences. In so doing, group identity is explored and the prospect for creating partnerships across disciplines (‘similarities rather than differences’) is considered.

The increasing use of the humanities in nurse education provides an alternative means of facilitating students' understanding of health issues. In part, this contributes to a critique of rationalist-technological approaches to education where knowledge is reduced to abstract, discernable and measured units. A more communal approach to education recognises the place of interpretation as part of learning and, within this, the significance of dialogue, identity, tradition, attachment and partnership. The reading of works of literature is one way in which the reader interprets texts in a multiplicity of ways in order to more fully understand the 'real' world. Mental health offers particular opportunities for literary descriptions. The evaluation of a learning unit within a mental health nursing branch programme where students read a number of works of literature is outlined. Results indicate a variety of student responses to use of such an approach. The authors assert the usefulness of these approaches in encouraging deeper understanding of complex issues faced in mental health nursing practice. At the same time, however, careful consideration is given to the place of such approaches within the overall philosophy of a curriculum programme.

Donor-derived hematopoiesis was assessed in 17 patients who received allogeneic marrow grafts from HLA-matched siblings between 1971 and 1980. Complete blood counts were normal or near normal in all patients except one. Chimerism analyses, using either dual-color XY-chromosome fluorescence in situ hybridization (FISH) or analysis of variable number tandem repeat loci, indicated that 15 out of 16 patients had greater than 97% donor-derived hematopoiesis, whereas 1 patient had indeterminate chimerism. All 12 recipients of grafts from female donors exhibited polyclonal hematopoiesis by X-linked clonal analysis with the use of molecular probes. Of the 17 recipients, 9 exhibited a less than 1.0-kilobase shortening of granulocyte telomere length compared with their respective donors, according to terminal restriction fragment analysis or flow-FISH with a fluorescein-labeled peptide nucleic acid probe. These data suggest that under standard transplantation conditions, the stem cell proliferative potential is not compromised during hematopoietic reconstitution.

Background. The aims of this study were to ex vivo expand canine dendritic cells and determine their phenotype and functional characteristics. Methods. CD34 + -selected cells and CD34 + -depleted canine bone marrow (BM) cells were cultured in Iscove's modified medium for 14 days. Cytokines added to the cultures included human granylocyte/ macrophage colony-stimulating factor 5 ng/ml, hFlt3 ligand 200 ng/ml, and human tumor necrosis factor-a 10 ng/ml. Cultured cells and purified subpopulations were assessed for cell surface antigen expression, morphology, and function by flow cytometric analysis, electron microscopy, and an allogeneic mixed lymphocyte reaction at day 14. Results. Two main cell populations were identified, DR ++ (bright)/CD14 -- and DR + (dim)/CD14 + . Ex vivo expanded CD34 + -selected cells showed increased allostimulatory activity compared to both cultured CD34 + -depleted cells and mononuclear cells. In contrast, ex vivo expansion from CD34 + -depleted cells was unsuccessful. After sorting cells from the ex vivo expanded CD34 + -selected bone marrow to enrich for DR ++ /CD14 -- cells, a 42-fold increase (median) of allostimulatory activity was observed as compared with sorted DR + /CD14 + cells (P=0.02). Conclusions. Cells with dentric cell-like phenotypes and functions can be cultured from canine CD34 + -selected bone marrow cells. Future studies will address the roles of these cells in engraftment, graft versus host reactions and graft-host tolerance in a canine hematogoietic stem cell transplantaton model.

This paper explores the differences and similarities that may exist in respect of using the interview method in phenomenological and grounded theory methodologies. Baker et al. set out to differentiate between method in grounded theory and phenomenology and concluded that it was essential to ensure that the method matches the research question being asked. However, the paper, whilst clear in intent to differentiate between the methodologies of phenomenology and grounded theory, does little to help the researcher in the differences that may exist in carrying out such research using the same method, that is, interviewing. Interviewing has become synonymous with qualitative research and may become the accepted method of data collection irrespective of methodology. We postulate that the interview as a method of data collection may be inconsistent with the underlying principles of the methodology (phenomenology or grounded theory). Should this be the case then the interview as a means of collecting data may be viewed as generic and lack a clear connection to the methodological framework. Such a position could be consistent with a critique of qualitative nursing research on the grounds of rigour.

Three hundred and forty-five questionnaires containing the knowledge and attitude scale for ECT devised by Janicak et al. (1985) were distributed to mental health nurses working in Wales, the data were collected from the 167 returned. Limitations in the reliability of the instrument with respect to the degree of internal consistency were found, this suggested that the knowledge statements used were inconsistent in providing a reliable measure of respondents knowledge of ECT. Findings suggested that a higher level of knowledge appeared to be associated with the length of experience of the nurse and their area of clinical practice. In addition, there were substantial variations in actual knowledge, particularly with regard to cognitive side-effects with ECT. Attitudes to ECT in this study were significantly related to the place in which the nurse was practising and the degree of contact the nurse had with patients receiving the treatment. Greater knowledge scores were obtained by those nurses who indicated a more positive response towards ECT. The conclusions suggest that knowledge of ECT required improvement in many cases, and this has implications for nurse education. A relationship between knowledge and attitudes appears to exist in this study, however, such a relationship would need to be tested further in future research.

The Clinical Resource and Audit Group (2002) guidelines emphasise that local policies should make the procedure for deciding and maintaining patient observation levels clear.To investigate the views of nurses, doctors and other members of the multidisciplinary team on patient observation.A postal survey of all acute adultinpatient facilities and intensive patient care units in Scotland was carried out, followed by 38 interviews, 37 with staff members and one with a service user.We found a lack of multidisciplinary team involvement, limited pre agreed plans for nurses to reduce levels of observation and limited use of validated risk assessment tools.There is a need to ensure that local practice follows national policy recommendations more closely.

Summary The five-year experience of a group of nursing lecturers teaching the expressive arts within a Scottish degree programme is outlined and discussed. The place of the arts is contextualised within curriculum developments and module content, sequencing, thematic development, mode of delivery, assessment, student evaluation and pedagogical approaches are all addressed. Relationship to practice is discussed in terms of the art of nursing, reflection, ethics and spirituality. Future developments are discussed in terms of drawing upon the wider resources of the humanities, rather than merely expressivist sources of art. The paper concludes by encouraging the teaching of the arts in nurse education to remain responsive to practice issues and to consideration of students' learning needs.

Background There is a long history of nursing practice in the area of electroconvulsive therapy (ECT). Opinions on the involvement of nurses in this treatment reflect the wider debate on its use in the professional and popular media. There is extensive literature on the issues raised by this particular treatment but little research into what nurses actually do when working with patients receiving ECT. Objectives The research question was: How do mental health nurses work with patients having electroconvulsive therapy? Design This was a Grounded Theory adopting a ‘hybrid' approach to the methodology influenced by the differing perspectives of both co-originators, Glaser and Strauss. Settings The research took place in wards and ECT departments in two hospitals in Scotland. Participants Twenty-four mental health nurses, including 4 students working in National Health Service hospitals in Scotland were accessed through purposive, then theoretical sampling. This included non-participant observation of nurses in their work with patients throughout the treatment period and unstructured interviews. Methods Analysis was based upon the constant comparative approach with open coding of data that was examined and compared for similarities and differences. This determined further data collection and theoretical development with regard to their properties and relationships to other codes until the point of saturation. Results Nurses' actions in ECT characteristically involve two role groups: relational roles and treatment roles and two dilemmas: uncertain role and uncertain relationships. The core category 'being there' comprising 'engaged', 'present' and ‘detached' accounts for nurses' actions in the ECT drama, approaches to difficulties encountered, and, paradoxically, how such actions contributes to this. Slipping is postulated as the basic social psychological process enabling nurses to manage their contact with the patient.

To characterize recombinant human macrophage-colony stimulating factor (rhM-CSF)-associated thrombocytopenia (TCP), in vivo studies were performed in dogs, including the biodistributions and recoveries of radiolabelled autologous and allogeneic platelets. rhM-CSF induced a reversible, dose-dependent decrease in platelet counts. The number of megakaryocytes in spleen and marrow of rhM-CSF-treated dogs was increased two to threefold. Recoveries of allogeneic platelets transfused from rhM-CSF-treated donors into tolerized recipients (n = 3) were not significantly different from allogeneic baseline studies (93 +/- 10% of baseline values at 24 h and 90 +/- 1% at 40 h), whereas autologous platelets infused back into rhM-CSF-treated donors had decreased recoveries (45 +/- 2% of baseline values at 24 h, P = 0.03 and 20 +/- 4% at 40 h, P = 0.001). Platelet biodistribution studies showed increased accumulation of radiolabelled platelets over the spleens and livers of rhM-CSF-treated dogs. Histochemistry showed increased levels of platelet-specific antigen (CD41; glycoprotein IIb) associated with Kupffer cells. The sensitivity of platelets from rhM-CSF-treated dogs to activation from thrombin, as measured by expression of P-selectin (CD62P), was not significantly different when compared with baseline studies (P = 0.18; n = 4). These results support the concept that rhM-CSF induces an activation of the monocyte-macrophage system (MMS), which causes a reversible TCP in a dog model.

Graft-versus-host (GVH) reactions contribute to stable engraftment of allogeneic hematopoietic stem cell transplants. It was hypothesized that the in vivo expansion of recipient dendritic cells (DC) with the administration of ligand for Flt3 (FL) could promote allogeneic engraftment after reduced-intensity conditioning by enhancing the GVH effect.FL was first administered to three nonirradiated healthy dogs for 13 days at a dosage of 100 microg/kg/day. Next, nine dogs received 4.5 Gy total-body irradiation (TBI) and unmodified marrow grafts from dog leukocyte antigen (DLA)-identical littermates without posttransplant immunosuppression. FL was administered to the recipients at a dosage of 100 microg/kg/day from day -7 until day +5.In normal dogs, FL produced significant increases in monocytes (CD14+) and neutrophils in the peripheral blood, a marked increase in CD1c+ cells with DC-type morphology in lymph nodes, and increased alloreactivity of third-party responders to peripheral blood mononuclear cells in mixed lymphocyte reactions (P0.001). Sustained engraftment was observed in eight of nine (89%) FL-treated dogs compared with 14 of 37 (38%) controls (P=0.02, logistic regression). All engrafted FL-treated dogs became stable complete (n=2) or mixed (n=6) hematopoietic chimeras without significant graft-versus-host disease (GVHD). Recipient chimeric dogs (n=4) were tolerant to skin transplants from their marrow donors but rejected skin grafts from unrelated dogs within 7 to 9 days (median, 8 days).In this study, the authors showed that FL administered to recipients promotes stable engraftment of allogeneic marrow from DLA-identical littermates after 4.5 Gy TBI without significant GVHD.

Sublethally irradiated NOD/SCID mice were transplanted with hematopoietic progenitor cells obtained from the marrow of patients with myelodysplastic syndromes (MDS). Engraftment of MDS cells, as determined by flow cytometry, was delayed compared to marrow from normal donors. Human CD38(+)CD34(-) cells were prominent in marrows and spleens of MDS chimeras. CD34(+)CD38(-), CD34(+)CD38(+) and T cells were also easily detected. Human myeloid cells (CD33(+); CD15(+)) were present in low proportions. No clonal precursors were identified by fluorescent in situ hybridization (FISH) or by molecular analysis of polymorphic X-linked markers in mice with documented engraftment of human cells more than 2 months after transplantation. These data indicate that human cells present in murine MDS chimeras, at the levels of sensitivity of our assays, were derived from residual normal cells in human MDS marrow, and suggest that the NOD/SCID environment was not conducive to the expansion of clonal MDS precursors. This model may allow identification of factors relevant for sustaining or expanding clonal precursors.

We hypothesize that immune tolerance after allogeneic hematopoietic cell transplantation is maintained by an active cellular mechanism that includes T reg CD4 + CD25 + cells. In the dog model of mixed hematopoietic chimerism, adoptive immunotherapy with donor lymphocyte infusion (DLI) that successfully converted recipients to all-donor chimerism required the breaking of immune tolerance to target antigens. We reasoned that depletion of T reg cells might break tolerance and could improve the therapeutic efficacy of subsequent DLI. Denileukin diftitox (DAB 389 IL-2, Ontak) is a fusion protein consisting of the translocation and ADP-ribosylase domains of diphtheria toxin and interleukin 2. DAB 389 IL-2 binds to the high affinity IL-2 receptor (CD25, CD122 and CD132) expressed on the cell surface of activated T cells. Some T reg cells express the high affinity IL-2 receptor. Although DAB 389 IL-2 has been shown to deplete alloreactive T cells, we asked if DAB 389 IL-2 could deplete T reg cells without depleting alloreactive T cells in dog mixed lymphocyte cultures (MLC). First we asked if DAB 389 IL-2 could induce specific cell death of activated T cells. Five days after initiation of a one-way, dog leukocyte antigen (DLA)-mismatched MLC, DAB 389 IL-2 was added to the MLC for 24 hours and cells were pulsed with 3 H-thymidine. At 10 −11 and 10 −10 M [DAB 389 IL-2] there was 34% and 92% inhibition of cell proliferation, respectively. To determine if DAB 389 IL-2 could deplete T reg cells, we established DLA-mismatched MLC (n=5) with cyclosporine (CSP) 400ng/mL (Martin, PJ et al. BBMT, 2004) and added DAB 389 IL-2 in half-log increments from 10 −11 to 10 −9.5 M on day 4 of MLC. On day 5, culture medium was changed to remove DAB 389 IL-2 and cells were analyzed for expression of CD4 and CD25. Flow cytometric analysis showed that CSP treated MLC had reduced CD4 + CD25 bright and CD4 + CD25 dim by 90 ± 3.3% and 64 ± 10%, respectively, compared to no CSP. DAB 389 IL-2 [10 −11 M] treatment of MLC with CSP decreased CD4 + CD25 bright and dim populations 31 ± 12% and 30 ± 4%, respectively, compared to no DAB 389 IL-2. On day 10 of the culture, cells were tested in secondary (2°) MLC to determine the effect of depleting CD4 + CD25 + cells with DAB 389 IL-2. 2° MLC was performed without the addition CSP or DAB 389 IL-2. After 3 days of 2° MLC, cells were assayed for proliferation. Compared to controls with no CSP or DAB 389 IL-2 treatment during 1° MLC, depletion of CD4 + CD25 + cells with DAB 389 IL-2 increased 2° allo-specific proliferation 36.2 ± 26%. When CSP was present in the 1° MLC, DAB 389 IL-2 treatment on day 4 increased subsequent 2° MLC allo-specific T cell proliferation 86 ± 22%. These results are consistent with the hypothesis that DAB 389 IL-2 can efficiently eliminate T reg (CD4 + CD25 + ) cells, particularly when T reg cells are generated in the presence of CSP.

This study investigates the potential role of the recombinant c-mpl ligands (recombinant human thrombopoietin [rhTPO] and pegylated recombinant human megakaryocyte growth and development factor [PEG-rhMGDF]) on the recovery of platelet counts after TBI with and without allogeneic hematopoietic stem cell transplantation (HSCT) in an established canine model. Initially, 3 cohorts, each with 2 nonirradiated dogs, received increasing doses of rhTPO (5 microg/kg per day; 10 microg/kg per day; 20 microg/kg per day) for 7 days to determine the optimal dose. The dose of 10 microg/kg per day of rhTPO was selected for subsequent studies. Ten dogs then received either rhTPO or placebo for 28 days after 200 cGy TBI without HSCT. The rhTPO group had fewer days with platelet counts 20,000/microL) for the PEG-rhMGDF group (n = 10) was 14.0 days compared to 15.5 days for the control group (n = 10; log rank, P = .35). There were no significant differences in the total time to platelet counts 500/microL. The effects of rhTPO on recovery of platelet and granulocyte counts after sublethal TBI were modest, and no effects of PEG-rhMGDF were observed on hematopoietic recovery after high-dose TBI and allogeneic HSCT. The significant effect that rhTPO-specific antibodies had on the platelet counts may limit the clinical role of recombinant c-mpl ligands unless sensitization can be prevented.Biol Blood Marrow Transplant 2002;8(7):360-7.