The use, publication and future directions of immunocytochemistry in veterinary medicine: a consensus of the Oncology-Pathology Working Group.

One of the primary objectives of the Oncology Pathology Working Group (OPWG), a joint initiative of the Veterinary Cancer Society and the American College of Veterinary Pathologists, is for oncologists and pathologists to collaboratively generate consensus documents to standardize aspects of and provide guidelines for oncologic pathology. Consensus is established through review of relevant peer-reviewed literature relative to a subgroup's particular focus. In this document, the authors provide descriptions of the literature reviewed, the review process, and a summary of the information gathered on immunocytochemistry. The intent of this publication is to help educate practitioners and pathologists on the process of immunocytochemistry and to provide a guide for the use of this technique in veterinary medicine. This document represents the opinions of the working group and the authors and does not constitute a formal endorsement by the American College of Veterinary Pathologists or the Veterinary Cancer Society.

Cytologic Criteria for Mast Cell Tumor Grading in Dogs With Evaluation of Clinical Outcome.

A 2-tiered histologic grading scheme for canine cutaneous mast cell tumors (MCTs) is based on morphologic characteristics of neoplastic cells, including karyomegaly, multinucleation, nuclear pleomorphism, and mitotic figures. Aspirates from MCTs may provide the same information more quickly, inexpensively, and less invasively. This study used these criteria to develop a cytologic grading scheme for canine MCTs to predict outcome. Three anatomic pathologists graded histologic samples from 152 canine MCTs. Three clinical pathologists evaluated aspirates from these masses using similar criteria. A cytologic grading scheme was created based on correlation with histologic grade and evaluated with a kappa statistic. Survival was evaluated with Kaplan-Meier survival curves. Cox proportional hazards regression was used to estimate hazard ratios for tumor grades and individual grading components. Simple logistic regression tested for relationships between risk factors and mortality. The cytologic grading scheme that best correlated with histology (kappa = 0.725 ± 0.085) classified a tumor as high grade if it was poorly granulated or had at least 2 of 4 findings: mitotic figures, binucleated or multinucleated cells, nuclear pleomorphism, or >50% anisokaryosis. The cytologic grading scheme had 88% sensitivity and 94% specificity relative to histologic grading. Dogs with histologic and cytologic high grade MCTs were 39 times and 25 times more likely to die within the 2-year follow-up period, respectively, than dogs with low grade MCTs. High tumor grade was associated with increased probability of additional tumors or tumor regrowth. This study concluded that cytologic grade is a useful predictor for treatment planning and prognostication.

Holoprosencephaly and Pure Red Cell Aplasia in a Feline Leukaemia Virus-Positive Kitten.

A 9-month-old, female, domestic longhair cat with severe anaemia tested positive for feline leukaemia virus (FeLV) and was humanely destroyed and submitted for necropsy examination. Gross findings included a non-divided rostral telencephalon, consistent with semilobar holoprosencephaly. Histological examination of the bone marrow revealed an almost complete absence of erythroid precursor cells, consistent with pure red cell aplasia, and mild to moderate myelofibrosis. This case demonstrates a very unusual central nervous system defect, as well as an atypical presentation of pure red cell aplasia, in a FeLV-positive kitten.

Acute pancreatitis in two five-day-old Appaloosa foals.

Severe acute pancreatitis (SAP) in foals is rare and treatment has not been documented. This paper describes the clinical, haematological and ultrasonographic findings as well as attempted treatment of SAP in two 5-day-old Appaloosa fillies. Clinical signs, including colic, diarrhoea and coma, may be mistaken for sepsis or neonatal encephalopathy. Hyperlipaemic serum and peritoneal fluid, and elevated serum and peritoneal fluid amylase and lipase activities aided the diagnosis. Severe acute pancreatitis should be included as a differential in an acutely ill foal with diarrhoea, colic, cerebral cortica dysfunction and hyperlipaemia.

Transferrin receptor expression in canine lymphoma.

Transferrin receptor 1 (TfR1) expression was measured by immunohistochemistry in 78 archived cases of canine B-cell and T-cell lymphoma with an anti-human TfR1 monoclonal antibody that was validated in the dog by immunohistochemistry and immunoblotting. The canine lymphoma cases were initially classified on the basis of World Health Organization criteria and then subdivided into the following 4 subgroups: low-grade B-cell (LGB), high-grade B-cell (HGB), low-grade T-cell (LGT), and high-grade T-cell (HGT). A visual scoring system and densitometric analysis of the proportion and intensity of positive staining were used to quantify TfR1 expression. TfR1 expression was also correlated to mitotic rate. TfR1 expression was significantly lower in the LGT tumors compared to all other lymphoma subgroups (LGB, HGB, and HGT). LGB tumors showed a TfR1 expression similar to those of the high-grade tumors (HGB and HGT). Significant correlations were found between mitotic rate and densitometric TfR1 variables in the T-cell tumors but not in the B-cell tumors. Further studies are needed to investigate the underlying molecular basis of the high TfR1 expression in LGB lymphomas and its pathological relevance. The anti-human TfR1 monoclonal antibody is a useful tool for measurement of total cellular transferrin receptor expression in the dog; however, an antibody with specificity for the canine TfR1 ectodomain is needed to investigate the potential of this receptor as an oncolytic target.

Effective psychological care for physically ill patients in hospital.

This article introduces the concept of psychological care as part of a holistic approach to nursing practice. Its primary focus is on the psychological care needs of general medical and surgical patients in hospital, but the principles introduced and discussed are broadly relevant to a wide range of nursing and healthcare settings and contexts.

The DIURNAL project: DIURNAL and circadian expression profiling, model-based pattern matching, and promoter analysis.

The DIURNAL project ( http://diurnal.cgrb.oregonstate.edu/ ) provides a graphical interface for mining and viewing diurnal and circadian microarray data for Arabidopsis thaliana, poplar, and rice. The database is searchable and provides access to several user-friendly Web-based data-mining tools with easy-to-understand output. The associated tools include HAYSTACK ( http://haystack.cgrb.oregonstate.edu/ ) and ELEMENT ( http://element.cgrb.oregonstate.edu/ ). HAYSTACK is a model-based pattern-matching algorithm for identifying genes that are coexpressed and potentially coregulated. HAYSTACK can be used to analyze virtually any large-scale microarray data set and provides an alternative method for clustering microarray data from any experimental system by grouping together genes whose expression patterns match the same or similar user-defined patterns. ELEMENT is a Web-based program for identifying potential cis-regulatory elements in the promoters of coregulated genes in Arabidopsis, poplar, and rice. Together, DIURNAL, HAYSTACK, and ELEMENT can be used to facilitate cross-species comparisons among the plant species supported and to accelerate functional genomics efforts in the laboratory.

Understanding the research process in nursing.

This article provides an overview of the research process in nursing, outlining a logical and structured approach to answering research questions. Illustrations from a hypothetical research study are used to outline procedures that are relevant to NHS research.

Promoting health care safety through training high reliability teams.

Many organizations have been using teams as a means of achieving organizational outcomes (such as productivity and safety). Research has indicated that teams, especially those operating in complex environments, are not always effective. There is a subset of organizations in which teams operate that are able to balance effectiveness and safety despite the complexities of the environment (for example, aviation, nuclear power). These high reliability organizations (HROs) have begun to be examined as a model for those in other complex domains, such as health care, that strive to reach a status of high reliability. In this paper we analyse the components leading to the effectiveness of HROs by examining the teams that comprise them. We use a systems perspective to uncover the behavioral markers by which high reliability teams (HRTs) are able to uphold the values of their parent organizations, thereby promoting safety. Using these markers, we offer guidelines and developmental strategies that will help the healthcare community to shift more quickly to high reliability status by not focusing solely on the organizational level.

How to turn a team of experts into an expert medical team: guidance from the aviation and military communities.

There is no question that interdisciplinary teams are becoming ubiquitous in healthcare. It is also true that experts do not necessarily combine to make an expert team. However when teams work well they can serve as adaptive systems that allow organisations to mitigate errors within complex domains, thereby increasing safety. The medical community has begun to recognise the importance of teams and as such has begun to implement team training interventions. Over the past 20 years the military and aviation communities have made a large investment in understanding teams and their requisite training requirements. There are many lessons that can be learned from these communities to accelerate the impact of team training within the medical community. Therefore, the purpose of the current paper is to begin to translate some of the lessons learned from the military and aviation communities into practical guidance that can be used by the medical community.

Psychological care in nursing education and practice: a search for definition and dimensions.

Despite a wealth of literature from the medical and nursing arenas pointing to the significance of psychological care in illness, there appears to be little consensus on definition, description and dimensions of the concept. A literature review and analysis of textbook content was conducted to explore the nature of the concepts of psychological need and care which might inform nurse educationalists in the preparation of appropriate teaching and learning programmes. Preliminary findings indicate that there is little consensus upon definition or description and, with the exception of information-giving, upon the dimensions or components of psychological care, despite the fact that student nurses are prepared to meet the same nationally prescribed learning outcomes by pursuing broadly the same guidelines for educational content. It is suggested that this has particular implications for nursing lecturers with a responsibility for teaching the philosophy and practice of holistic care.

Novice and expert perceptions of psychological care and the development of psychological caregiving abilities.

Despite the wealth of research pointing to the centrality of psychological care in illness, there appears to be a lack of consensus concerning its nature and the means by which psychological caregiving abilities are acquired. This has an impact on nurse educators, who must identify and harness the perceptions which students hold, and identify the processes which might contribute to their skill development, as they progress from 'novice' to 'expert'. The aims of this small qualitative study were to compare novice and expert perceptions of the nature of psychological care, and to identify those processes that may contribute to nurses' ability to apply psychological understanding in practice. Data collection methods comprised interactive interviews with qualified and novice student nurses, which were analysed thematically using an adaptation of Colaizzi's (1978) reductive procedure. Results suggest that, whilst there is considerable overlap in themes identified between the two groups, novices consider a broader range of themes to be central to psychological caregiving than do experts; similarly, novices identify more contributory factors than do experts in explaining the process of acquiring skill in psychological caregiving. Possible reasons for these differences are considered. Whilst this study is limited in size and scope, the ultimate goal is to utilize central themes within a model of psychological caregiving, which might inform nurse education. In this way, educational programmes might be appropriately focused upon students' needs within the context of real clinical experience.

Designing and implementing a 'dual diagnosis' module: a review of the literature and some preliminary findings.

People with a learning disability experience the full range of mental health problems, with prevalence greater than in the general population. The literature suggests that the move to community care has highlighted their special needs, as they face a complexity of life experiences and risks. Nurses play a key role, and must be equipped with appropriate knowledge and expertise to respond to the mental health problems of people with a learning disability ('dual diagnosis'). Major national initiatives support research and propose access to appropriate education for care professionals. In order to respond to locally identified educational needs a 'dual diagnosis' module was developed for nurses working with people with a learning disability who experienced mental health difficulties. The aims were to increase knowledge, to consider implications for learning disability nursing, to increase awareness of research and policy issues, and ultimately to enhance practice. Preliminary findings suggest that participants have moved from an entry position of professional bias and lack of knowledge and skill, to a changed perspective and enhanced practice relating to the mental health needs of clients with a learning disability. These changes are, however, speculative and may be attributable to variables other than module completion. Implications for further research and development are suggested.

Assessing students' clinical performance.

In this article the authors review the history of clinical assessment and describe the development and implementation of an evidence-based assessment strategy for clinical practice prepared for the Diploma in Nursing curriculum at Keele University.

Achieving interprofessional working in mental health.

Interprofessional collaboration in health care has been high on the political agenda in recent years. However, despite several government reports, progress has been relatively slow. Several structural and organisational challenges need to be addressed, alongside the development of valid research in this field, to accelerate the pace of change. This article describes how interprofessional education, in conjunction with service initiatives, offers a way forward for the development of collaborative practice based on users' and carers' needs.