Somatic embryogenesis of Prunus subhirtella autumno rosa and regeneration of transgenic plants after Agrobacterium-mediated transformation.

Embryogenic lines of Prunus subhirtella autumno rosa were established on a modified MS medium supplemented with 1 mg/l NAA, 0.06 mg/l IBA and 0.04 mg/l BA from petioles of axenically grown shoots of adult origin. To induce normal development of plantlets we compared a range of approaches on solid culture media as well as in suspension cultures including treatments with ABA, GA3, zeatin, darkness, and cold. A series of experiments were conducted to follow the temporal pattern of somatic embryo development.Separation of embryos at different stages of development was carried out by sieving the suspension cultures through nylon nets. While the embryogenic masses were used for further subcultures, well formed embryos were used for germination experiments.Transformed Prunus subhirtella plants were regenerated from somatic embryos by inoculating an embryogenic callus with Agrobacterium strain LBA 4404 containing the ß-glucuronidase (GUS) gene on plasmid pBinGUSint. Several putative transformed embryogenic calli were selected for continued proliferation on kanamycin containing media. Finally transgenic plants were regenerated on shoot multiplication medium containing kanamycin. Embryos and plants were shown to express the GUS gene by histochemical assays and northern blot analysis. With a yield of 110 transgenic lines from a single transformation experiment this approach appears ideal for the study of the influence on level of expression caused by different copy number, site of insertion etc. This will be helpful in establishing parameters according to which the best transgenic line for a chosen purpose should be selected.

Compliance with emergency department referral: the effect of computerized discharge instructions.

STUDY OBJECTIVE: To examine the effect of computerized discharge instructions on emergency department patient referral recommendations. DESIGN: Prospective, descriptive analysis and clinical trial. SETTING: Emergency medicine residency-affiliated urban hospital with 568 beds and 29,000 annual visits. TYPE OF PARTICIPANTS: One thousand ED patients discharged to an outpatient referral network during a six-week period. INTERVENTION: Mandatory referral was provided in written or computerized (Logicare Corp, Eau Claire, Wisconsin) format for each 500-patient group. Demographic data and compliance, measured as appointment completion within 30 days, were analyzed using chi 2 with Yates' correction, Fisher's exact, and odds ratio comparisons (P < .05, 95% confidence interval). MEASUREMENTS AND MAIN RESULTS: The institution of computerized discharge instructions resulted in increased overall patient compliance from 26.2% to 36.2% (P < .0008) with odds ratio of 1.59 (1.2 to 2.1). Subset analysis showed increased compliance in patients who were more than 40 years old (32.5% to 61.1%), were female (28.7% to 39.7%) with a private physician (36.4% to 53.9%), established hospital relationship (26.1% to 38.9%), had nonurgent complaints (26.5% to 36.2%), were specifically diagnosed with strain or contusion (17.0% to 36.8%), or were referred to obstetrics/gynecology clinic (13.2% to 48.6%) (P < .001). CONCLUSION: Computerized discharge instructions were associated with improved compliance with ED referral recommendations, based on historic and contemporary controls.

Compliance with emergency department patient referral.

This study evaluated the nature and efficacy of compliance with emergency department (ED) patient referral recommendations. This was a prospective, nonrandomized, descriptive analysis of all ED patients referred mandatorily to an established urban hospital follow-up network. Compliance was measured by analysis of hospital records determined as appointment completion. Patient demographics, urgency of complaint, hospital relationship (new versus established), diagnosis (International Classification of Diseases-9CM), specialty, and method of payment, defined as clinic or private referral, were determined. Comparisons between groups used Fisher's exact test and chi 2 analysis (alpha = 0.05). There were 2,185 patients encountered with 1,443 (66%) discharged for referral, and an overall compliance rate of 27.8% (401 patients). Patients had a mean age of 36.9 years; 50.6% were male, 94.4% were established patients, 51.1% were clinic cases, and 96.7% had nonurgent complaints. Patients encountered had higher rates of compliance if female (33.9%), greater than 40 years of age (43.4%), with urgent complaints (46.8%), and if referred to private physicians (37.0%) (P less than .001). Compliance also correlated with the diagnosis of fracture (63.3%) or laceration (45.6%); and specialty referral to obstetrics-gynecology (28.4%) and general surgery (22.4%) consultants (P less than .01). Most patients demonstrate low compliance (28%) with follow-up recommendations, even with a directed ED referral system.

Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study.

Four hundred sixty-seven adult victims of blunt trauma undergoing cervical spine radiography (CSR) were prospectively studied to identify any clinical parameters which would aid in the selective application of CSR. Eight persons (1.7%), six of whom were alert and two who presented comatose, sustained cervical spine injuries. In this study, persons injured in falls demonstrated a statistically significant greater risk of cervical spine injury compared to those injured in motor vehicle accidents (p = 0.001). In alert trauma victims, a statistical correlation with cervical spine injury was noted for individuals who had complaints of neck discomfort (p = 0.028) and for patients who manifested tenderness to neck palpation (p = 0.000039). No cervical spine injury was noted in any alert, not intoxicated, neurologically intact patient who had no complaints of neck discomfort upon questioning or palpation. We conclude that alert trauma victims with no complaints of neck discomfort upon questioning and with no tenderness on neck palpation need not undergo CSR.

Emergency department daily record review: a quality assurance system in a teaching hospital.

A system of daily patient chart review of 11 categories of physician documentation and patient care was implemented over a 36-month period at Allegheny General Hospital in Pittsburgh. A total of 108,317 charts of emergency patients were reviewed. Feedback on errors in all categories were given to the physicians responsible, and necessary corrective actions were taken as soon as possible. All new resident physicians rotated in two-month blocks and received orientation to patient care and chart documentation expectations prior to starting the service. All physicians' charts underwent the same thorough chart review. Not only did the percentage of errors decrease from the first months to the second months of the residents' rotations, but the yearly percentage of total errors decreased as the study progressed, from 5.47% to 3.57%.