A comparison of fibrinogen measurement using TEG(®) functional fibrinogen and Clauss in cardiac surgery patients.

INTRODUCTION: Viscoelastic methods of estimating fibrinogen measure clot formation under platelet inhibition; these methods are gaining in popularity because of their convenience and speed. The aim of this study was to compare the results of the TEG(®) functional fibrinogen (FF) assay with the Clauss fibrinogen method in a group of patients presenting for cardiac surgery and to assess whether they gave equivalent results. METHODS: As part of a larger study evaluation a transfusion algorithm for use in cardiac surgery, 320 paired samples of TEG(®) FF and Clauss fibrinogen were compared. These were taken from 160 patients undergoing cardiac surgery at two time points - prior to heparinisation and 10 min after the administration of protamine. The results of the two fibrinogen measurements were also analysed in relation to the platelet count at the time. RESULTS: There was no significant correlation between the TEG(®) FLEV and Clauss fibrinogen at baseline (R(2) = 0.106) or 10 min postprotamine (R(2) = 0.025) The TEG(®) FF maximal amplitude and the Clauss were also found to have no significant correlation (at baseline R(2) = 0.061), at 10 min postprotamine (R(2) = 0.260). Bland-Altman analysis showed no significant agreement between the two methods. CONCLUSION: The TEG(®) FF does not produce results equivalent to those of the Clauss fibrinogen regardless of platelet count.

Regulation of prehospital nursing practice: a national survey.

INTRODUCTION: In 1988, the National Flight Nurses Association and ENA published a revised joint position statement advocating that registered nurses (RNs) "should not be required to certify as Emergency Medical Technicians (EMTs) at any level before assuming a nursing role in the prehospital environment." The position endorsed a collaborative role with emergency medical services agencies, regulation of prehospital nursing by state nursing agencies, and additional educational requirements in areas unique to prehospital emergency care. This study examines the existing state of affairs in the regulation of prehospital practice of RNs throughout the United States. METHODS: Data were obtained by review of written state rules and regulations pertaining to certification of prehospital care providers and by telephone survey of state emergency medical services agencies nationwide. RESULTS: All 50 (100%) of the states were contacted. In 44 of the 50 states (88%), no certification in prehospital nursing exists. As a result, most states require that RNs become EMTs at some level as a prerequisite for prehospital practice. Of these states, 36% (16/44) allow RN substitution to meet ambulance staffing requirements without additional certification requirements. Of these states, 61% (27/44) require RNs to complete the entire EMT curriculum to obtain certification, whereas 39% (17/44) allow challenge examinations in combination with varying other educational requirements. Nursing "certification" for prehospital practice exists in 12% (6/50) of states. DISCUSSION: As a nation, we are far from actualizing the recommendations stated in the ENA and National Flight Nurses Association position.

Cloning of the regulatory gene areA mediating nitrogen metabolite repression in Aspergillus nidulans.

The areA gene, which mediates nitrogen metabolite repression in the fungus Aspergillus nidulans, lies sufficiently close to a telomere that no indispensable gene can be distal to it. We were able therefore to exploit the existence of a near terminal pericentric inversion to devise a method for cloning areA plus the region beyond it towards the telomere. In crosses heterozygous for this inversion a class of duplication-deficient progeny lacking areA and the region centromere-distal to it is obtained. We, therefore, sought clones from an A. nidulans gene library in lambda Charon 4 able to hybridize to total genomic DNA from a wild-type strain but not to that from a duplication-deficiency strain. A clone, containing an 11.6-kb insert, which hybridised weakly to duplication-deficiency DNA, overlapped chromosome breakpoints of three different aberration-associated areA alleles and was able to transform an areA mutant to areA+. Southern blotting and genetic analysis established that the transforming sequence had integrated in the region centromere distal to areA. The cloning method yielded other clones from the region centromere-distal to areA which were used to show that the translocation associated with a mutant areA allele is reciprocal rather than non-reciprocal, a fact which could not be established by classical genetics. Finally, analysis of the cloned portion of the dispensable region centromere-distal to areA indicates that this region contains at least 0.5% of the A. nidulans genome.