In and out: an analysis of epibiotic vs periplasmic bacterial predators.

Bdellovibrio and like organisms (BALO) are obligate predators of Gram-negative bacteria, belonging to the α- and δ-proteobacteria. BALO prey using either a periplasmic or an epibiotic predatory strategy, but the genetic background underlying these phenotypes is not known. Here we compare the epibiotic Bdellovibrio exovorus and Micavibrio aeruginosavorus to the periplasmic B. bacteriovorus and Bacteriovorax marinus. Electron microscopy showed that M. aeruginosavorus, but not B. exovorus, can attach to prey cells in a non-polar manner through its longitudinal side. Both these predators were resistant to a surprisingly high number of antibiotic compounds, possibly via 26 and 19 antibiotic-resistance genes, respectively, most of them encoding efflux pumps. Comparative genomic analysis of all the BALOs revealed that epibiotic predators have a much smaller genome (ca. 2.5 Mbp) than the periplasmic predators (ca. 3.5 Mbp). Additionally, periplasmic predators have, on average, 888 more proteins, at least 60% more peptidases, and one more rRNA operon. Fifteen and 219 protein families were specific to the epibiotic and the periplasmic predators, respectively, the latter clearly forming the core of the periplasmic 'predatome', which is upregulated during the growth phase. Metabolic deficiencies of epibiotic genomes include the synthesis of inosine, riboflavin, vitamin B6 and the siderophore aerobactin. The phylogeny of the epibiotic predators suggests that they evolved by convergent evolution, with M. aeruginosavorus originating from a non-predatory ancestor while B. exovorus evolved from periplasmic predators by gene loss.

Nursing leaders of tomorrow: a peer selection process.

AIMS: This paper describes a case presentation of a process for using peer evaluation to identify and select new nursing leaders in hospital settings. BACKGROUND: A reliable method for identifying emerging leaders has yet to be defined. Often, it is based only on managerial observation and evaluation, and does not involve staff opinion. METHODS: We developed a three-tiered selection process consisting of: confidential peer voting, head nurse recommendations and a personal interview. RESULTS: Forty-three potential leaders were enrolled in our leadership training workshop. Twelve graduates of this workshop were chosen to fill leadership positions in the hospital. CONCLUSIONS: Peer recognition of potential nursing leaders might serve as a critical component in the process of selecting future nursing leaders. IMPLICATIONS FOR NURSING MANAGEMENT: Combining peer evaluation with structured leadership selection may be beneficial for the early recognition of future nursing leaders. This approach is not commonly used in the leader identification and selection process. It may contribute to a sense of trust between management and staff, and promote transparency as well as legitimacy in the selection process.

Report of a continuous quality improvement program in a tertiary-care medical center.

OBJECTIVE/DESIGN: Changes in the health system in Israel have led to an increasingly competitive environment, decentralization, and economic constraints. We evaluated the use of a continuous quality improvement (CQI) program. SETTING: Three medical departments and three administrative wings in a 700-bed, tertiary-care, teaching hospital in Jerusalem. INTERVENTION: The program was planned as a short-term pilot project for long-term extension throughout the institution. The objectives were improved institutional efficiency and provision for change. The program was implemented through departmental improvement teams under a hospital management team and a steering committee, guided by an outside consultant firm. RESULTS: The Orthopedics Department experienced a 3-day reduction in patient length of stay (P<.008). The Emergency Room experienced a significant reduction in time to discharge through reduced waiting times for consulting physicians (P<.007) and for blood tests (P<.001). The Office of Patient Admissions streamlined procedures for admission and discharge, accomplished physical restructuring, and installed a telephone hot line. In Medical Records, a significant improvement in records availability was realized. In Outpatient Clinics, reductions in waiting times were realized, but were not statistically significant. The Supply Division showed savings on monthly orders and increased efficiency, with 95% of orders completed promptly and accurately. CONCLUSIONS: Several factors were identified as essential to the success of the program, including staff cooperation and commitment. We conclude that the CQI program was a useful tool to help our tertiary-care medical center adjust to changes in the Israeli healthcare system. It also served as a valid vehicle for maintaining and furthering optimal quality of care.

[Program for operating teams for quality improvement of hospital services].

In mid-1992, improvement of quality of service was set as a major goal in the framework of a 5-year plan at this hospital. This subject was selected in preparation for a new era in health care emerging in the world in general, and in Israel in particular. 6 problematic departments with high potential for improvement were chosen for the first stage of implementing a total quality management program (TQM). The goal was to gain experience through the implementation of TQM in a few medical and nonmedical departments in preparation for implementing TQM in the entire hospital. This process is ongoing and the first conclusions and perspectives are now being studied by all involved.