A strategy for continuous assessment of theory and practice in first level nursing courses.

In May 1988, the English National Board (ENB, Statutory Body for Nursing Education for England) issued draft proposals for development of continuous assessment of theory and practice in basic nursing courses. As an integral part of a new curriculum the staff at Wolverhampton School of Nursing have developed a strategy for continuous assessment of theory and practice which now has formal ENB approval. In order to qualify as a person who can apply to be registered on one or more parts of the register students must have demonstrated their ability to acquire the competencies which are specified in Rule 18(1) of the Nurses, Midwives and Health Visitors Rules Approval Order (UKCC 1983). The strategy demonstrates the development and achievement of competencies of Rule 18(1) as they increase in complexity. We do not claim that the strategy is the only framework which could be developed for implementing continuous assessment, nor do we claim that it is flawless. The strategy is intended as a framework which may contribute in assisting other nurse teachers who are in the present position of developing such schemes of assessment.

A comparison of nurse-related behaviour, philosophy of care and job satisfaction in team and primary nursing.

The study compares team and primary nursing modes of organization of nursing care on three related variables, namely: nurse-related behaviour and quality of care, philosophy of care and job satisfaction for nurses. The historical dimension and evolution of modes of care, quality of care, philosophy of care and theories of job satisfaction are discussed within the context of the study. The literature and previous research studies conducted on team and primary nursing are reviewed and comparisons of the two are made. Analysis of data collected yielded results which are compared for differences and benefits between team and primary nursing. The results of the study suggest that when compared to team nursing mode of organization of care, primary nursing affords increased quality of care, a more coherent philosophy of nursing and increased job satisfaction for nurses. Methodological problems are examined and implications for policy explored.

Reactivity of anti-peptide and anti-poliovirus type 3 monoclonal antibodies with synthetic peptides.

Monoclonal antibodies were prepared from mice immunized with an 18-residue synthetic peptide with an amino acid sequence from a major antigenic sequence involved in the neutralization of type 3 poliovirus. Approximately 250 hybridomas secreted antibodies that reacted with the peptide but not the virus, two antibodies reacted with the virus but not the peptide and no antibody reacted with both. Conversely 26 monoclonal antibodies prepared from mice immunized with type 3 poliovirus and known to be directed against the appropriate sequence on the virus, generally failed to react with the peptide. These results might be expected if only a small proportion of the free or coupled peptide molecules adopt molecular conformations which resemble that of the homologous antigenic site in the virus. Antibodies specific for other antigens occasionally reacted well with the synthetic peptides, indicating that antibodies may bind to peptides of inappropriate sequence. The identification of antigenic sites by the use of synthetic peptides therefore requires considerable caution.

United Kingdom scheme for external quality assessment in virology. Part I. General method of operation.

Developments in the United Kingdom national external quality assessment scheme for virology are described. There are about 198 participants (170 in the UK) who are enrolled for examination of any or all of five categories of specimen (distribution types). These are detection of rubella antibody (128 UK participants), detection of hepatitis B surface antigen (130 UK participants), general virus serology (86 UK participants), virus identification (85 UK participants), and electron microscopy (56 UK participants). Specimens of a sixth category (rubella IgM antibody), not yet formally established, have also been distributed to 67 UK participants. Specimens in each distribution type are sent out once or twice a year, and, except for rubella IgM antibody, participants have been given a score of 2, 1, 0 or -1 marks for their reports on each specimen. Their cumulative scores and performance ratings are calculated retrospectively over a 12 month period for each distribution type separately and for combined distributions. The performance rating is defined by the number of standard errors by which the individual's cumulative score differs from the mean for all participants and carries a + or - sign depending on whether the cumulative score lies above or below the mean. Performance ratings have been found generally to be close to the mean in rubella serology and detection of hepatitis B surface antigen but are more variable in virus identification and electron microscopy. Ratings of less than -1.96 are considered to be significantly worse than average and to constitute poor performance.

United Kingdom scheme for external quality assessment in virology. Part II. Specimen distribution, performance assessment, and analyses of participants' methods in detection of rubella antibody, hepatitis B markers, general virus serology, virus identification, and electron microscopy.

Methods for the preparation and pre-distribution testing of specimens for external quality assessment in virology have been defined and criteria for allocation of scores for participants' reports on each category of specimen have been established. Specimens for detection of rubella antibody or markers of hepatitis B infection consist of human serum samples, which are distributed after detailed assessment of the expected results. In testing for rubella antibody or hepatitis B surface antigen (HBsAg) the scores given for reports of positive, equivocal, or negative depend on the specimen's content of antibody or HBsAg as established in the external quality assessment laboratory. For general virus serology two serum samples must be tested against a designated antigen by the complement fixation method; the score allocated for each participant's results depends on the ratio of the two titres he records, which is then compared with a target value derived from the results of a panel of participating laboratories. In virus identification and electron microscopy specimens are prepared from cultures or from clinical samples, and scores depend on the accuracy of identification. The pre-distribution tests necessary to establish the virus content and stability of these specimens have been defined, and media suitable for transporting specimens for virus culture, fluorescent antibody staining, or electron microscopy have been developed. A participant's overall success rate for each specimen is judged from the mean score (maximum 2) calculated from the scores of all participants examining the specimen. Mean scores were highest for detection of rubella antibody or HBsAg (from 1.67 to 1.96) and lowest for specimens containing certain small enteric viruses distributed for electron microscopy (0.82 to 1.12). Participants' reports on the methods used for each specimen have been analysed. Current changes and developments in methods have been recorded, and attempts have been made to relate the use of various techniques and test kits to successes or failures with various types of specimen.

The behaviour of recent isolates of human respiratory coronavirus in vitro and in volunteers: evidence of heterogeneity among 229E-related strains.

Strains of human coronavirus (HCV) isolated between 1974 and 1976 have been studied in vitro and in volunteers. All strains caused colds in volunteers, and those cultivable in tissue culture (TC) produced significantly more coryza and less sore throat than strains growing only in organ culture (OC). The TC strains were serologically related to 229E, but these isolates produced colds with a frequency and severity that contrasted with the effects of 229E itself. Tests on volunteers' preinfection sera showed that the prevalence of antibody to 229E had increased during the period 1961-1979 and that during 1977-1979 only 11% of subjects had no neutralising antibody against 229E. Susceptibility to the 229E-related isolates PR and TO was associated with low preinfection serum neutralising antibody against the homologous virus, and paired sera frequently showed fourfold or greater antibody rises, most commonly against the homologous strain. Volunteers infected with TO were immune when reinoculated with the same strain approximately 1 year later, but other similar volunteers were at least partly susceptible to infection with a heterologous 229E-related virus after similar time intervals. Although the strains of HCV that were grown in tissue culture were all related to the prototype 229E, they appeared not to be identical with it, and this heterogeneity is probably a significant factor in the epidemiology of HCV infections.

Two antigenic groups of human coronaviruses detected by using enzyme-linked immunosorbent assay.

Paired sera from volunteers inoculated with one of the five recently isolated strains of human coronavirus (HCV), AD, GI, HO, PA, and RO, none of which has been grown in tissue culture, or with strain OC38 were tested against coronavirus antigens by enzyme-linked immunosorbent assay. When HCV strains OC43, 229E, or the 229E-related tissue culture-adapted strains PR and TO were used as antigens, it was shown that all strains fell into one of two antigenic groups. The HCV OC43 group was comprised of strains OC43, GI, HO, and RO, and the HCV 229E group contained strains AD and PA as well as the tissue culture-adapted strains PR, TO, and KI. Enzyme-linked immunosorbent assay of the paired sera with the coronavirus mouse hepatitis virus strain 3 as antigen confirmed the relationship of this virus to the HCV OC43 group but not to the HCV 229E group.

Antibody to virus components in volunteers experimentally infected with human coronavirus 229E group viruses.

Antibody rises to various virus subcomponents were measured by enzyme-linked immunosorbent assay in the paired sera of volunteers experimentally infected with human coronavirus 229E group viruses. Most of the antibody made during infection was directed against the virus surface projections, with only small amounts of antibody made against membrane or ribonucleoprotein components.

Enzyme-linked immunosorbent assay for detection of antibody in volunteers experimentally infected with human coronavirus strain 229 E.

An enzyme-linked immunosorbent assay was developed for detecting antibody rises to human coronavirus strain 229E and related strains in paired sera from infected volunteers. There was a close correlation between development of colds infected volunteers. There was a close correlation between development of colds and significant antibody rises detected by the enzyme-linked immunosorbent assay. Furthermore, the assay was more sensitive than a neutralization assay. This enzyme-linked immunosorbent assay is an easy, accurate, and sensitive assay for measuring significant antibody rises to human coronavirus strain 229E group viruses, and it could be useful in the clinical diagnosis of these infections.

Isolation of rhinoviruses and coronaviruses from 38 colds in adults.

Nasal washings were collected from 27 normal adults during 38 naturally acquired colds. The washings were exhaustively tested using tissue cultures, organ cultures and electron microscopy. Washings yielding no identifiable agent were inoculated into human volunteers, and further specimens obtained from the latter were examined by the same techniques in vitro. Viruses were identified in association with 25 of the original 38 colds (65.7%). Fifteen were rhinoviruses (39.5%), seven coronaviruses (18.4%), two were para-influenza viruses, and one was influenza virus. Use of organ cultures and of volunteers significantly increased the isolation rate. No agent was cultivated from the remaining 13 specimens, although tests in volunteers showed that cold-producing agents were present in five of them (13%). Three specimens gave doubtful results in volunteers, and five others, all collected within a period of six weeks in December and January, apparently contained no infectious agent.

Inhibition of rhinovirus replication in in organ culture by a potential antiviral drug.

The compound 2-amino-1-(isopropyl sulfonyl)-6-benzimidazole phenyl ketone oxime (LY122771-72) at a concentration of 0.2 microgram/ml completely inhibited rhinovirus replication in human embryonic nasal organ cultures, although in the absence of virus the compound did not inhibit ciliary activity when used at a concentration of 25 micrograms/ml. When added 26 hr after infection, the compound stopped rhinovirus production in organ cultures that had already started to release virus. Five rhinovirus types available for infection of volunteers and six recently obtained clinical isolates were shown to be more sensitive to LY122771-72 in tissue culture than the rhinovirus type 31 used in the organ culture experiments. These results suggest that this potential antiviral drgu should be evaluated in humans.

Role of viruses and bacteria in acute wheezy bronchitis in childhood: a study of sputum.

Sputum, nasal swabs, and throat swabs were obtained from 22 children aged between 5 and 15 years during 72 attacks of wheezy bronchitis. A virus, most commonly a rhinovirus, was isolated in 49% of all episodes and in 64% of 22 severe episodes requiring treatment with corticosteroids; the isolation rate was higher early in the illness than later. Virus was recovered more often from sputum than from the nose or throat, suggesting that viral replication occurs freely in the lower respiratory tract: the cytological findings in sputum were compatible with an inflammatory response to viral infection. Pathogenic bacteria appeared to play a minor role compared with viruses, and routine antibiotic treatment was probably of little value in moost cases. The significance of the results is discussed in relation to the pathogenesis of childhood wheezy bronchitis.

Astrovirus infection in volunteers.

An extract and a filtrate prepared from feces of a child with mild gastroenteritis were shown by electron microscopy to contain numerous astrovirus particles and were given to eight volunteers by mouth. One subject developed diarrheal illness and concurrently shed large amounts of astrovirus in feces, and one other had mild constitutional symptoms with a lower level of virus shedding. Nine other volunteers were given fecal filtrate from the volunteer with diarrhea, and astrovirus shedding subsequently occurred in two of them. The syndrome accompanying virus shedding appeared distinct from that associated with the "W" agent in previous experiments. Thirteen of 16 astrovirus-inoculated subjects subsequently developed a rise in titer of the homologous antibody in serum. It was concluded that astrovirus causes a transmissible infection that is of low pathogenicity for adults. Immunofluorescence of human embryo kidney cells inoculated with astrovirus and shown by electron microscopy to contain 28 nm virus-like particles was used both to detect virus in feces and to assay astrovirus antibody.