Continuous training based on the needs of operating room nurses using web application: a new approach to improve their knowledge.

INTRODUCTION: Since university education and intensive and limited pre-service training do not provide an acceptable level of performing the duties of operating room nurses, and considering the limitations of traditional training methods in the field of operating room; This study was conducted with the aim of determining the effect of using the electronic education approach based on web application, leveled, personalized and based on the needs of nurses on their level of knowledge and satisfaction. MATERIALS AND METHODS: This research is a quasi-experimental type of single-group multi-center pre-test-post-test, which during that, four stages of educational needs assessment, educational content design, web application design for training and evaluation of operating room nurses and determining the effectiveness of this method are included. Based on their knowledge and satisfaction, during this period, 36 nurses from the operating rooms that met the study criteria were included in the study by stratified random sampling based on the determined sample size. The data collection includes a four-choice test to measure the knowledge of operating room nurses in heart anatomy (score range 0-20), the principles of movement, transferring and positioning of the patient in the operating room (score range 0-15), the principles of ergonomics in the operating room (score range score 0-10) and satisfaction questionnaire (score range 0-28). Data collected using descriptive statistical tests (percentage of frequency and frequency, mean and standard deviation) and analytical tests (paired sample t-test, independent samples t-test, ANOVA, Pearson correlation, chi-square) with the software SPSS version 16 was analyzed. RESULTS: Generally, the average knowledge scores of operating room nurses before and after the intervention were 5.96 ± 3.96 vs. 13.6 ± 3.77, in the course of principles of moving, transferring and positioning the patient in the operating room were 6.3 ± 3.42 vs. 13.3 ± 1.32, respectively 8.7 ± 3.97 vs. 18.1 ± 1.07 (in heart anatomy), 1.57 ± 2.6 vs. 0.73 ± 9.1 (in the principles of ergonomics in the operating room) and the average Knowledge scores after the intervention were significantly higher than before the intervention (P<0.001). Also, the average satisfaction score of nurses was 21.3 ± 5.83 and 22 nurses (64.7%) were satisfied with the e-learning course. CONCLUSION: The use of the electronic education approach based on the web application, leveled, personalized and based on the needs of the nurses, led to the improvement of the level of knowledge and satisfaction of the operating room nurses. E-learning can be used as a complementary educational tool and method for continuous training of operating room nurses in other specialized fields of operating room and surgery. HIGHLIGHTS: • Educational content in the form of educational videos taught by professors of medical sciences universities on each of the topics of heart anatomy (28 episodes of 5-10 minutes), principles of ergonomics in the operating room (7 episodes of 5-25 minutes) and movement principles. The transfer and positioning of the patient in the operating room (16 episodes of 10-20 minutes) were designed in three primary, intermediate and advanced levels. • The results of this study showed that the use of an electronic education approach based on the web application, levelled, personalized and based on the needs of nurses, led to the improvement of the knowledge of operating room nurses. Also, operating room nurses were delighted with electronic training courses. E-learning can be used as a complementary educational tool and method for continuous training of operating room nurses in other specialized fields of operating room and surgery. • Based on the results of this study, the use of an electronic education approach based on the needs of operating room nurses can be used as a complementary tool to conventional continuous education. Since this method allows interactive, personalized education is levelled, and asynchronous. It can be used at any time and place on a laptop, tablet or mobile phone; a wide range of operating room nurses in the hospitals of the Islamic Republic of Iran can use it for educational justice to Many borders should be established in the country. However, there are studies to evaluate the generalizability and the effect of using the e-learning approach on the clinical skills of operating room nurses and to compare the effect of e-learning with other methods and educational tools on the knowledge and skills of the learners and the extent of consolidating the learned material in their memory.

Quantum and classical effects in DNA point mutations: Watson-Crick tautomerism in AT and GC base pairs.

Proton transfer along the hydrogen bonds of DNA can lead to the creation of short-lived, but biologically relevant point mutations that can further lead to gene mutation and, potentially, cancer. In this work, the energy landscape of the canonical A-T and G-C base pairs (standard, amino-keto) to tautomeric A*-T* and G*-C* (non-standard, imino-enol) Watson-Crick DNA base pairs is modelled with density functional theory and machine-learning nudge-elastic band methods. We calculate the energy barriers and tunnelling rates of hydrogen transfer between and within each base monomer (A, T, G and C). We show that the role of tunnelling in A-T tautomerisation is statistically unlikely due to the presence of a small reverse reaction barrier. On the contrary, the thermal populations of the G*-C* point mutation could be non-trivial and propagate through the replisome. For the direct intramolecular transfer, the reaction is hindered by a substantial energy barrier. However, our calculations indicate that tautomeric bases in their monomeric form have remarkably long lifetimes.

Modelling proton tunnelling in the adenine-thymine base pair.

The energies of the canonical (standard, amino-keto) and tautomeric (non-standard, imino-enol) charge-neutral forms of the adenine-thymine base pair (A-T and A*-T*, respectively) are calculated using density functional theory. The reaction pathway is then computed using a transition state search to provide the asymmetric double-well potential minima along with the barrier height and shape, which are combined to create the potential energy surface using a polynomial fit. The influence of quantum tunnelling on proton transfer within a base pair H-bond (modelled as the DFT deduced double-well potential) is then investigated by solving the time-dependent master equation for the density matrix. The effect on a quantum system by its surrounding water molecules is explored via the inclusion of a dissipative Lindblad term in the master equation, in which the environment is modelled as a heat bath of harmonic oscillators. It is found that quantum tunnelling, due to transitions to higher energy eigenstates with significant amplitudes in the shallow (tautomeric) side of the potential, is unlikely to be a significant mechanism for the creation of adenine-thymine tautomers within DNA, with thermally assisted coupling of the environment only able to boost the tunnelling probability to a maximum of 2 × 10(-9). This is barely increased for different choices of the starting wave function or when the geometry of the potential energy surface is varied.

Genetic and molecular characterization of uveal melanoma cell lines.

The recent identification of frequent activating mutations in GNAQ or GNA11 in uveal melanoma provides an opportunity to better understand the pathogenesis of this melanoma subtype and to develop rational therapeutics to target the cellular effects mediated by these mutations. Cell lines from uveal melanoma tumors are an essential tool for these types of analyses. We report the mutation status of relevant melanoma genes, expression levels of proteins of interest, and DNA fingerprinting of a panel of uveal melanoma cell lines used in the research community.

Genetic test and periodontal disease.

Periodontitis initiated by specific bacteria that activate host mechanisms destroying bone and connective tissues that support the teeth. It has a relative high prevalence in the population, representing the greatest cause of tooth loss. Like any other inflammatory condition, periodontal diseases might pose additional risk for susceptible people, contributing to serious diseases such as coronary heart disease and stroke, preterm low birth weight babies, and the regulation of blood glucose level in diabetics or respiratory diseases. At the present time, diagnosis of periodontal disease relies primarily on clinical and radiographic. Thus, application of microbial diagnosis in periodontics is limited. The role of genetic factors in periodontal disease is now well recognized and genetic susceptibility test became commercially available.

Acid-base status and fructose diphosphatase activity in rats exposed to fluoride and induced periodontitis.

This study was conducted to evaluate acid-base status and fructose diphosphatase (FDPase) activity in 40 (4 groups of 10) male Wistar rats. One group of rats was left untreated as control, fed a standard diet, and given distilled water. Periodontitis model induced with 5 mg/kg NH4Cl (group 1), exposed to sodium fluoride (NaF) at the concentration 5 mg/l (group 2), exposed to NaF (5 mg/l) and supplemented with minerals and vitamins (group 3). At the termination of experimental period (30 days) the pH and pCO2 value of arterial blood were analysed. Then, the FDPase activity in the hemogenized heart, kidney liver, mandible, pelvis, and teeth were determined by measuring inorganic phosphate that converts from fructose-1.6-diphosphate and using spectrophotometer at 350 nm. The differences in the acid-base status and FDPase activity in the groups 1 and 2 were statistically significant in comparison with the control and group 3 (P < 0.001). Increased FDPase activities are associated with acid-base status. The minerals and vitamins supplementation proved to restore acid-base balance, reduce toxicity and establish steady enzyme activity, which has not been previously reported.

Influence of supplementary vitamins and minerals on lipid peroxidation and redox state in heart, kidney and liver of rats exposed to fluoride.

The effect of fluoride (F) and supplementary vitamins and minerals on lipid peroxidation (LPO) and redox state (RS) in heart, kidney and liver of 40 (4 groups of 10) male Wistar rats were studied. One group of rats was left untreated as control, group 1 was received 5 mg/l NaF in their drinking water, group 2 was received 5 mg/l NaF in their drinking water plus vitamins (A, C, and D) in their diet, and group 3 was received 5 mg/l NaF in their drinking water plus vitamins (A, C, and D) and minerals (Mg-, Mn-, Zn-sulfate, and Na-citrate) in their diet. In comparison with the group 2, 3 and controls, elevated malondialdehyde (MDA) content in the group 1 indicated an increase in LPO product. In addition, unsteady ratios of oxidized to reduced nicotinamide adenine dinucleotide (NAD+/NADH) reflected significant alterations in the RS status. These results demonstrate that the combination of vitamins and minerals supplementation proved to restore MDA content and establish steady RS status that has not been previously reported.

Oral cancer: risk factors, prevention and diagnostic.

Although oral cancer is rare and attracts little attention, it ranks 12th among all cancers and constitutes the most life threatening of all dental conditions. The aetiology of oral cancer is multi-factorial and like other types of cancer, the key to decreasing the suffering of patients and increasing their survival rate is early detection. The global increase in frequency and mortality of oral cancer has intensified current research efforts in the field of prevention and early detection of this disease. Therefore, scientists have been searching for alternative approaches to biopsy. A number of molecular-based diagnostic markers have been used to detect the presence of oral cancer with varying degrees of sensitivity and specificity. In this paper, incidence, mortality, risk factors, prevention, and diagnostic of oral cancer have been reviewed.

Salivary malondialdehyde levels in clinically healthy and periodontal diseased individuals.

BACKGROUND: Lipid peroxidation (LPO) has been implicated in the pathogenesis of several pathologic disorders, including periodontal disease. Malondialdehyde (MDA) is one of many low molecular weight end products of LPO. OBJECTIVE: This study was conducted to evaluate salivary MDA levels in generalized chronic periodontitis (GCP) subjects. MATERIALS AND METHODS: The MDA levels were measured in the saliva of 104 subjects, aged 18-65 years. Three groups with different degrees of severity of GCP were established: 30 early (group 1), 30 moderate (group 2) and 14 severe (group 3). Thirty individuals (aged 25-29 years) with clinically healthy periodontium were served as control. Unstimulated whole saliva samples from study subjects were collected, centrifuged at 3000 g for 15 min and were then stored at -70 degrees C until analysed. The MDA level was determined with 2-thiobarbituric acid by a colorimetric method at 532 nm. RESULTS: A significant increase in the MDA level existed in the samples obtained from the three groups of patients compared to the control subjects. CONCLUSION: Increased MDA levels are with closely associated with the severity and patients status of periodontal disease that has not been previously reported. The detection of salivary MDA level may provide additional advantages in elucidating the pathogenesis of periodontal disease.

Periodontal disease: an overview for medical practitioners.

In recent years, many new study reports have linked poor oral health to poor general health. Oral health is fundamental to overall health, well-being and quality of life. It goes far beyond having sound white teeth and no cavities. Periodontitis is one of the most ubiquitous diseases and is characterized by the destruction of connective tissue and dental bone support after an inflammatory host response secondary to infection by periodontal bacteria. Severe periodontitis, which may result in tooth loss, is found in 5-20% of most adult populations worldwide. Scientific evidence has emerged in the field of periodontology linking periodontitis to a person's overall health. Medical practitioners could play a pivotal role in the promotion of oral health. Most medical practitioners do not know general health periodontitis implications, are not trained to diagnose periodontal disease, and are not sensitised to refer high-risk patients to the dental practitioners. Early detection and carefully managed therapeutics with the medical and dental practitioners working hand-in-hand may prove beneficial to the patient's general health and quality of life. This article will review risk factors for developing periodontal diseases as well as a brief overview of variety medical conditions that can develop if the patient has pre-existing periodontal disease, which might be useful for medical practitioners.

Oral cancer and role of general dental practitioners in its early detection.

Oral cancer constitutes the most life threatening of all dental conditions. The oral cavity is usually easily accessible for examination and thus offers the potential opportunistic screening for oral cancer. Alcohol and tobacco are two of the most important risk factors for development of oral cancer. There is clear need to inform and educate the public in matters relating to known risk factors. Primary prevention has been estimated to be the most cost-effective method. Diagnosis of oral cancer in its early stages dramatically affects survival rates. General dental practitioners play particularly important role in the early detection of oral cancer.

TCL1 shows a regulated expression pattern in chronic lymphocytic leukemia that correlates with molecular subtypes and proliferative state.

Expression of the human oncogene TCL1 in transgenic mice produces B-cell tumors that resemble chronic lymphocytic leukemia (CLL) suggesting its role in B-cell tumorigenesis. To clarify the expression pattern and regulation of TCL1 in CLL, we assessed 213 primary tumors by immunohistochemistry (IHC), flow-cytometry and/or Western blot, using a new monoclonal antibody. TCL1 protein was detectable in the majority of CLL (90% by IHC) but showed marked variations across cases with virtual absence in approximately 10% of tumors. Higher TCL1 levels correlated with markers of the 'pre-germinal center' CLL subtype including unmutated VH status (P=0.005), ZAP70 expression (P=0.007), and presence of chromosome 11q22-23 deletions (P=0.04). Intratumoral heterogeneity in TCL1 levels was also prominent and explained in part by markedly lower TCL1 expression in proliferating tumor cells. In vitro exposure of CLL cells to interleukin-4 (but not other growth factors) produced progressive and irreversible decrease in TCL1 protein levels in association with the onset of proliferation. TCL1 expression patterns in CLL are complex and highly dynamic and appear to reflect both the histogenetic subtypes of the disease and the growth parameters of individual tumors. The observed regulation pattern suggests that TCL1 may exert its effects predominantly in the unmutated/ZAP70-positive tumor subset.

A quantum mechanical model of adaptive mutation.

The principle that mutations occur randomly with respect to the direction of evolutionary change has been challenged by the phenomenon of adaptive mutations. There is currently no entirely satisfactory theory to account for how a cell can selectively mutate certain genes in response to environmental signals. However, spontaneous mutations are initiated by quantum events such as the shift of a single proton (hydrogen atom) from one site to an adjacent one. We consider here the wave function describing the quantum state of the genome as being in a coherent linear superposition of states describing both the shifted and unshifted protons. Quantum coherence will be destroyed by the process of decoherence in which the quantum state of the genome becomes correlated (entangled) with its surroundings. Using a very simple model we estimate the decoherence times for protons within DNA and demonstrate that quantum coherence may be maintained for biological time-scales. Interaction of the coherent genome wave function with environments containing utilisable substrate will induce rapid decoherence and thereby destroy the superposition of mutant and non-mutant states. We show that this accelerated rate of decoherence may significantly increase the rate of production of the mutated state.