Uncertainty of measurement for competitive and indirect ELISAs.

A method for the estimation of the uncertainty of measurements for Gaussian outcomes of enzyme-linked immunosorbent assay (ELISA) is described using competitive and indirect foot and mouth disease (FMD) ELISAs. Assay repeatability was determined by random effects analysis of variance, and the normality of the residuals was checked. The standard errors of the individual predicted values were transformed into confidence intervals around the corresponding observed values and further transformed into probabilities of being above/below a cut-off. Logistic regression models were subsequently used to interpolate probability values for the whole range of possible assay values. The uncertainty of measurement of a test result was finally defined as the probability of not observing the same qualitative test result when retesting the same sample. For the competitive ELISA any sample with a percent inhibition 4% above the cut-off value had an uncertainty level (probability of a negative result in the case of retest) below 5%. In the indirect ELISA with a cut-off OD of 0.1, the uncertainty was below 5% for any sample with a normalised OD value above 0.22.

Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine.

AIMS: The purpose of this study was to determine the knowledge level and attitudes of Israeli nurses towards complementary and alternative medicine and what factors are related to these variables. BACKGROUND: Over recent years there has been increased interest among the lay public and health care professionals in complementary and alternative medicine (CAM). Previous studies have shown that several variables such as education, income, age, perceived health status and satisfaction with medical therapy are associated with use of CAM. Conflicting reports were found with respect to the relationship between health locus of control and the use of CAM. Israel is a small country comprised mostly of immigrants from vastly differing cultures with differing beliefs about health and health care. Nurses whose origins are similar to the general population are also caregivers who are used to integrating diverse therapies into the plan of care devised with the client. No study was found which investigated these issues among Israeli nurses. DESIGN/METHODS: A systematic random sample of 369 staff nurses working at a major academic medical centre in Jerusalem, Israel were invited to participate in the study. Informed consent was obtained. Four self-administered, pencil and paper, questionnaires were distributed to the study participants: a questionnaire designed by the authors to determine the level of knowledge and attitudes towards complementary and alternative medicine; a questionnaire which measured satisfaction with the patient-physician relationship; a questionnaire which measured health locus of control; and a demographic questionnaire. Participants received a packet containing the questionnaire and a note explaining the study. The anonymous questionnaires were collected by the ward secretaries and sent in bulk to the researchers. RESULTS: Results demonstrated that nurses in this sample perceived that they had little knowledge of complementary and alternative medicine but were very interested in learning more. Few used complementary and alternative medicine in their nursing practice but levels of personal use were similar to that of the general population. Nurses who used complementary and alternative medicine were satisfied with their care. CONCLUSIONS: In general, nurses tended to be wary of the use of complementary and alternative medicine. Nurses were also not satisfied with their relationships with their physicians. Those of middle age were more likely to use complementary and alternative medicine but no other demographic characteristics were associated with knowledge or attitudes towards complementary and alternative medicine. Nurses had higher levels of internal health locus of control which was associated with more positive attitudes and knowledge levels of complementary and alternative medicine.

A non-theorist's perspective on nursing theory: issues of the 1990s.

The basis of all nursing endeavors, including practice and research, lies in theory. While nursing theorists are postulating and debating, practicing nurses are continuing with their daily routines and are often unaware that the world of nursing theory is changing. It is important, however, for all nurses to keep abreast of the latest developments in nursing theory. This article discusses some of the key developments within nursing theory based on a review of the nursing literature from 1990 through 1999.

[Reactions of patients to complementary medicine].

350 patients attending 11 large out-patient clinics completed questionnaires evaluating attitudes to, and experience with complementary medicine. 129 (36%) respondents reported using complementary medicine. 14% of them used complementary medicine for the current medical problem for which they were attending the clinic. Pain was the most common medical problem for which complementary medicine was used, followed by respiratory problems and cancer. Common therapeutic modalities used were acupuncture, homeopathy, nutrition and herbal medicine. Women, the secular as opposed to the religious, and those with higher education were more apt to use complementary medicine. No differences were found in age, national origin, length of living in Israel, and diet (vegetarian, natural foods or regular diet) between those who used complementary medicine and those who did not. No relationship was found between the use of complementary medicine and perceived poor health status, locus of control, or satisfaction with the doctor-patient relationship.

Activation of the adrenocortical axis by surgical stress: involvement of central norepinephrine and interleukin-1.

In the present study, we examined the mechanisms involved in the activation of the adrenocortical axis following surgical stress. Adult male rats underwent surgical laparotomy or craniotomy under ether anesthesia while control rats were only ether-anesthetized. Four hours following laparotomy or craniotomy, serum adrenocorticotropin (ACTH) and corticosterone (CS) were significantly increased and returned to almost basal levels after 24 h. Laparotomy also caused a significant depletion of corticotropin-releasing hormone (CRH-41) in the median eminence (ME). Pretreatment with dexamethasone 50 microg/kg completely abolished the pituitary-adrenal response while pretreatment with type II corticosteroid receptor antagonist caused a significant hypersecretion of both ACTH and CS and inhibited the effect of dexamethasone. The response to laparotomy was markedly attenuated in rats injected with 6-hydroxydopamine into the paraventricular nucleus (PVN) which significantly depletes norepinephrine (NE) PVN content. Intracerebroventricular injection of interleukin-1 receptor antagonist (IL-1ra) also inhibited the pituitary-adrenal response to laparotomy. The results suggest that (1) surgical stress activates the hypothalamo-pituitary-adrenal (HPA) axis via a mechanism which involves the release of CRH from the ME and NE input to the PVN; (2) the adrenocortical response is sensitive to the negative feedback of glucocorticoids via the mediation of type II glucocorticoid receptors, and (3) central IL-1 may be a mediator in the HPA axis response to surgical stress.

Patients' attitudes towards the use of gloves by healthcare staff.

There is a concern among healthcare providers regarding the use of gloves in non-mandated clinical situations and its impact on patient sensitivities. A convenience sample of 76 Israeli hospital inpatients were surveyed to measure patients' attitudes towards the use of gloves by healthcare providers. The Patient Sensitivity Questionnaire (PSQ) was developed and used to collect the data. Overall, patients were found to have a positive attitude towards the use of gloves in most patient care situations. Significant differences in patient attitudes towards glove use were found based on country of origin and number of hospital admissions in the previous year. The study concluded that hospitalized patients, in general, support healthcare providers' use of gloves. In addition, subjects agreed with the (American) Occupational Safety and Health Administration regulations regarding glove use.

Prerequisites and priorities for nursing research in Israel.

This article describes prerequisites and priorities for nursing research in Israel. The historical development of nursing research in Israel details shifts in types of research by decade from the 1960s through 1990s. The four phases of development and evaluation of nursing research are explored. Prerequisites for the development and growth of nursing research in Israel, as is true worldwide, include individual, professional, institutional and federal commitments. Priorities for Israeli nursing research include the development of a master plan which reflects its unique culture and geography.

Effect of exogenous nitric oxide and inhibitors of nitric oxide synthase on the hypothalamic pituitary adrenal axis responses to neural stimuli.

It has been shown that the hypothalamic-pituitary-adrenal (HPA) axis responses to immune-derived stimuli in particular can be modulated by nitric oxide (NO). In the present study we examined the effect of endogenous and exogenous NO on the HPA axis responses to neural stimuli which are not related to immune functions. Intracerebroventricular injection of NOR-3, a donor of NO, had no effect on basal HPA axis activity but significantly attenuated the secretion of median eminence (ME) CRH-41 as well as the serum ACTH and corticosterone (CS) in response to acute photic stimulation in a dose-dependent manner. Intracerebroventricular administration of N-omega-nitro-L-arginine methyl ester (L-NAME), a general NOS inhibitor, significantly enhanced ACTH and CS responses to this stress but did not change the basal levels of these hormones. On the other hand, i.c.v. injection of aminoguanidine, an inhibitor of inducible NO synthase (NOS) but not of neuronal NOS, did not affect the HPA axis responses to photic stimulation. These results suggest that: (1) NO is involved in modulation of the HPA axis responses to neural stimuli which are not dependent on immune factors, (2) the effect of NO is mediated by inhibition of hypothalamic ME CRH-41 secretion, and (3) this effect is probably mediated by neuronal NOS and not by inducible NOS.

Confirmation of HCV Antibodies by the Line Immunoassay INNO-LIA HCV Ab III.

HCVs constitute a genus within the Flaviviridae, with closest homology to the hepatitis G and GB viruses, and Pestiviruses. The positive-stranded RNA genome encodes at least nine proteins. Core, El, and E2 constitute the structural proteins; NS2, NS3, NS4A, NS4B, NS5A, and NS5B are nonstructural (NS) proteins. HCV isolates display high levels of sequence heterogeneity allowing classification into at least 11 types and 90 subtypes (1). HCV infection of the human liver is often clinically benign, with mild icterus in the acute phase, the disease may even go unnoticed in some cases of acute resolving hepatitis C. In the majority (>70%) of cases, however, HCV infection leads to chronic persistent or active infection, often with complications of liver cirrhosis and auto-immune disorders. Hepatocellular carcinoma may occur after about 20-35 yr (2); sometimes even without the intermediate phase of cirrhosis. No prophylaxis is available today and treatment with interferon-alpha (IFN-α) only leads to long-term resolution in about 4-36% of treated cases, depending on the HCV genotype (1).

Distress, symptom distress, and immune function in women with suspected breast cancer.

PURPOSE/OBJECTIVES: To investigate distress and its association with immune function among women with suspected breast cancer. DESIGN: Prospective, descriptive, correlational study. SETTING: An outpatient breast clinic at a tertiary urban hospital. SAMPLE: A convenience sample of women who had either a fine needle aspiration or open breast biopsy for a suspicion of breast cancer. Thirty-five women comprised the study sample, 6 with malignant and 29 with benign tumors. METHODS: Data were collected at three points in time. The first time (T1) was after the physician visit when the need for breast biopsy was ascertained. The second time (T2) was 7-10 days postbiopsy, and the third time (T3) was 7-10 days after T2. At T1, T2, and T3, participants filled out the Brief Symptom Inventory (a measure of psychological distress) and the Adapted Symptom Distress Scale (a measure of symptom distress) and provided a blood sample. Demographic data also were collected at T1. Immune function was measured by serum cytokine levels of transforming growth factor beta (TGF beta) and tumor necrosis factor alpha (TNF alpha). MAIN RESEARCH VARIABLES: Psychological distress, symptom distress, and immune function. FINDINGS: Psychological distress scores were moderate to high. Symptom distress was either nonexistent or slight. Significant correlations between psychological distress and symptom distress were found at T2 and T3. At T2, significant relationships between psychological distress and TNF alpha and between symptom occurrence and TNF alpha were found. Psychological and symptom distress scores were significantly different between women with malignant versus benign tumors at all three times. No differences in cytokine levels were found between the groups. CONCLUSIONS: These results suggest the strong effect that the diagnostic process has on psychological distress and its potential effects on immune functioning. Distress was significantly greater for women with malignant disease; however, women with benign disease continued to have elevated levels of distress. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be aware of the extremely stressful nature of the diagnostic phase and should continue to provide support, knowing that this distress continues throughout this phase, particularly for women diagnosed with malignancy.

Developing a research mentoring partnership in Israel.

A relationship begun in 1985 between the University of Pennsylvania School of Nursing and the Henrietta Szold Hadassah/Hebrew University has included a student exchange program and a faculty mentoring partnership. The student exchange focused on maternal-child nursing and led to the development of the faculty mentoring program. The goals of the latter program are to increase the expertise of the Israeli nursing faculty in the development of grant applications, publications, and abstracts and to develop a National Institutes of Health-supported research project with an Israeli nursing faculty as principal investigator.

Interactions of ACTH and TGF beta on monocyte proliferation: implications for trauma and burn patients.

The purpose of this study was to try to elucidate a possible biobehavioral mechanism associated with decreased immune function in trauma patients by determining whether there is an interaction between the effects of ACTH, a stress hormone, and TGF beta, a cytokine, on peripheral blood lymphocyte proliferation. Peripheral mononuclear lymphocytes (PMLs) from healthy donors were preincubated with varying concentrations of ACTH for 24 hr, stimulated with concanavalin A and increasing concentrations of TGF beta, and incubated for 72 hr. Proliferation was assayed by tritiated thymidine incorporation. A parallel aliquot of PMLs were incubated in the presence of ACTH to determine the direct effect of ACTH on mononuclear cell TGF beta production. While harvested supernatant from cells incubated in the presence of ACTH did not contain any detectable TGF beta, ACTH as well as TGF beta were found to significantly decrease cellular proliferation independent of one another. An even greater decrease in cellular proliferation was found when both ACTH and TGF beta were used, compared to either ACTH or TGF beta alone. These results suggest a biobehavioral interaction between ACTH and TGF beta at the cellular level and that interactions to relieve stress may assist in improving function and recovery from trauma.

Pooled human immunoglobulins contain anti-idiotypes with reactivity against the SLE-associated 4B4 cross-reactive idiotype.

OBJECTIVE: To identify anti-idiotype antibody activity against a regulatory anti-Sm idiotype (4B4) in pooled human IgG (IVIG). METHODS: ELISA were used to determine anti-idiotype antibody activity in IVIG. RESULTS: Anti-idiotype antibody activity to 4B4 was detected in IVIG. The anti-idiotypic activity in IVIG could be inhibited by antigen, Sm, and rabbit anti-idiotypic antiserum. The idiotypic binding activity was predominately directed against the 4B4 VH region. CONCLUSION: IVIG contains antibodies against a lupus-associated crossreactive idiotype. These antibodies represent Ab2 beta type antibodies. The anti-idiotypic activity in IVIG may be relevant to the efficacious use of IVIG in treating rheumatic diseases.

Surgeons and trauma care. Results of a North American satisfaction survey.

OBJECTIVE: To examine job satisfaction among trauma surgeons. DESIGN: Cross-sectional mail survey. SETTING: Hospital-based trauma care. PARTICIPANTS: Trauma surgeons in the United States and Canada. MAIN OUTCOME MEASURES: A 20-item Likert satisfaction questionnaire, three open-ended questions, and demographic data. RESULTS: Survey respondents were slightly dissatisfied with providing trauma care. The greatest sources of dissatisfaction were extrinsic, such as poor hours, low pay, and interference with a daily schedule. The major sources of satisfaction were personal, such as the challenging and rewarding nature of operative trauma care. Satisfaction was not statistically related to most aspects of the work environment or personal characteristics. CONCLUSIONS: Survey respondents strongly affirmed that operative trauma care was satisfying and that saving lives was challenging and rewarding. However, 40% of these respondents were seriously considering withdrawing from the trauma call roster.

Suburban geriatric trauma: the experiences of a level I trauma center.

BACKGROUND: As the mean age of the US population increases, so does the incidence of geriatric trauma. Investigators have shown that the elderly have high morbidity and mortality rates associated with traumatic injuries. OBJECTIVE: To compare the severity of injury, mortality, and functional outcomes of geriatric patients with younger patients admitted to a suburban trauma center. METHOD: A convenience sample of trauma patients who were 65 years old or older was compared with trauma patients who were 35 to 45 and 55 to 64 years old. Demographic data, injury data, Injury Severity Scores, Revised Trauma Scores, length of stay, and functional ability outcomes were abstracted from a trauma registry in aggregate form and then analyzed. RESULTS: The sample consisted of 766 subjects (age 35-45, n = 223; age 55-64, n = 135; age 65 and older, n = 408) with a mean age of 64.6 years. A larger percentage of the elderly were victims of falls; younger trauma patients were more likely to be victims of motor vehicle crashes. Significant differences were found between age groups on Glasgow Coma Scale scores. Revised Trauma Scores, and length of stay. Significant differences were not found on Injury Severity Scores, mortality rates, or functional outcomes. CONCLUSIONS: Although anatomic injury severity of elderly patients was similar to that of younger patients, the elderly demonstrated greater physiologic compromise and longer hospital stays. Mortality rates were lower for the elderly group, but this result might be because a larger proportion of elderly patients were hospitalized with minor or moderate injuries.

Use of physiologic variables in nursing research.

In this study, the use of physiologic variables is described in research reports published 1989-1993 in four broad-based research journals. The National Institute for Nursing Research (NINR) emphasizes the need for more physiologically based nursing research. This analysis documents the current number and proportion of such research reported in four journals during a 5-year period. Each report was evaluated for the population sampled, type of physiologic variable, type of study, definitions, and reporting of reliability and validity measures. Among the 763 reports, 114 (15%) examined physiologic variables. The most frequently studied physiologic variables were blood pressure, heart rate, and body temperature. The majority of studies posed and answered a clinical nursing question, and the study populations sampled were adults. Theoretical and operational definitions were included in most reports. Evidence of reliability and validity analysis were in 36% and 60% of the reports respectively. Although most nursing research focuses primarily on psychosocial aspects of care, several conceptual and psychometric issues were also addressed in studies that examined physiologic variables.

Trauma nursing research: a description and means of evaluation.

This article describes and discusses trends in trauma nursing research from 1988 to 1993, and provides a basis for evaluating this type of research. Trauma nursing research is divided into several topics: trauma prevention, prehospital care, acute care, outcome and rehabilitation, trauma systems and health policy, and trauma nursing education and administration. Variables specific to trauma, such as the trauma score, are identified and described. The contents of a research article and a means of evaluating each section of such literature are discussed.

Decreasing the cost of trauma care: a system of secondary inhospital triage.

The financial realities of the current health care arena make it imperative that deliverers of trauma care initiate programs that reduce the cost of trauma. Triage can be one process that attempts to attain this goal. Once patients are assigned to a Level I trauma center, it is possible to triage patients again to complement field triage. A two-tiered, inhospital trauma response system was developed in which different team responses are initiated depending on the patient status. This tiered, in-house response system differs with respect to human and material resources. Personnel, operating room, laboratory work, and protective wear savings account for approximately $1,042 per code patient, yielding an annual $629,404 institutional savings.

Trauma nurse coordinator: three unique roles.

Three nursing positions were created to effectively manage the Trauma Nurse Coordinator (TNC) role and responsibilities: Trauma Director, Clinical Nurse Specialist and Trauma Researcher. By using this innovative approach, the quality of trauma care improved as shown by decreased complication rates, lengths of stay, and trauma costs. In addition, trauma referrals, research and education increased.