The development of role adequacy for professional nurses in Jordan

AIM

This paper reviews the development of role adequacy in Jordan through an examination of nurse education, specialization and continuing education programmes in order to identify the developmental needs for the Jordanian professional nurse's initial and continued competence.

BACKGROUND

The concept of role adequacy in nursing relates directly to the skills and competencies of individuals who undertake the nursing role. Various types and levels of nursing education have been established with several reforms over time in attempt to meet the Jordanian nursing workforce's need for key competencies. A nursing council was established in 2002 but it has yet to guide professional development.

CONCLUSION

The nursing profession in Jordan has made great advances towards developing role adequacy over the last half century. Currently, there is a relatively good national system of educational preparation of nurses with the Bachelor of Science in Nursing degree providing the only point of entry to the profession. However, this draws heavily on North American curricula and textbooks and therefore may not be culturally and economically sensitive to the population's needs. The state of continuing education and specialist training in Jordan indicates there is an urgent need to set national minimum standards for continuing professional development requirements if nurses' role adequacy and continued competence are to be maintained. National cooperation between educational institutions, healthcare providers and the nursing regulatory body is needed if the goal of a competent nursing workforce is to be realized.

Promotion of physical activity by Canadian Registered Dietitians in daily practice

BACKGROUND

Dietitians are in an opportunistic position to promote healthy eating and active living. The purpose of this study was to determine counselling strategies of dietitians 1 year after attending a workshop designed to strengthen dietitians' self-efficacy for promoting physical activity (PA) as an adjunct to regular nutrition practice.

METHODS

A convenience sample of Registered Dietitians (RDs) in Alberta, Canada (n=103) responded to an invitation via an electronic newsletter to complete a web-based survey that asked about counselling practices related to PA.

RESULTS

Thirty-seven workshop attendees (n=37) were compared with a group of dietitians (n=66) who completed the survey but who did not attend the workshop. Nearly all (91%) respondents reported promoting PA in daily practice. Those who attended the workshop were more likely to refer clients to PA professionals (chi2=12.68, P<0.05) than those who were not workshop attendees.

CONCLUSIONS

Despite a relatively modest response rate, there were clear suggestions that RDs in Alberta, Canada promote PA in daily practice and attending a workshop designed to facilitate the use of specific tools and strategies for promoting PA in daily practice resulted in increased referral of their clients to exercise specialists.

Technical report: Magnetic resonance direct thrombus imaging at 3 T field strength in patients with lower limb deep vein thrombosis: a feasibility study

AIM

To investigate the feasibility of imaging lower limb deep vein thrombosis using magnetic resonance imaging (MRI) at 3.0 T magnetic field strength with an optimized a T1 magnetization prepared rapid gradient echo technique (MP-RAGE) in patients with normal volunteers as controls.

MATERIALS AND METHODS

Patients with deep vein thrombosis (n = 4), thrombophlebitis (n = 2) and healthy volunteers (n = 9) were studied. MRI of the distal thigh and upper calf was performed at 3.0 T with MP-RAGE using two pre-pulses to suppress blood and fat (flip angle 15 degrees, echo time 5 ms, and repetition time 10 ms). A qualitative analysis was performed for detection of thrombi and image quality. Contrast-to-noise ratios were determined in thrombosed and patent veins.

RESULTS

Thrombi were clearly visible as high-signal intensity structures with good suppression of the anatomical background. A blinded reader accurately diagnosed 15 out of 16 cases. The contrast-to-noise ratio measurements showed a positive contrast of thrombus over background muscle 16.9 (SD 4.3, 95% CI: 12.5-21.3) and a negative contrast of the lumen to muscle in patent veins of normal volunteers -7.8 (SD 4.3, 95% CI: -11.1 to -4.5), with p = 0.0015.

CONCLUSION

Thrombi generate high signal intensity at 3.0 T allowing for their direct visualization if flowing blood, stationary blood and fat are sufficiently suppressed. This preliminary data supports the development of these techniques for other vascular applications.

Cross-sectional estimation of Babesia bovis antibody prevalence in cattle in two contrasting dairying areas in Tanzania. ACTA ACUST UNITED AC 2004;71:211-7. [PMID: 15580770 DOI: 10.4102/ojvr.v71i3.262]

The crude prevalence of antibodies to Babesia bovis infection in cattle was estimated by serology using indirect ELISA during the period January to April, 1999. Sera were obtained from 1 395 dairy cattle (of all ages, sexes and breeds) on smallholder farms, the majority being kept under a zero grazing regime. The crude prevalence of antibodies to Babesia bovis was 6 % for Tanga and 12% for Iringa. The forces of infection based on the age sero-prevalence profile, were estimated at six for Iringa and four for Tanga per 100 cattle years-risk, respectively. Using random effect logistic regression as the analytical method, the factors (variables) of age, source of animals and geographic location were hypothesised to be associated with sero-positivity of Babesia bovis in the two regions.

Evaluation of PCR to detect Theileria parva in field-collected tick and bovine samples in Tanzania

The ability of PCR to detect infections of Theileria parva, the cause of East Coast Fever, in field-collected tick and bovine samples from Tanzania was evaluated. PCR-detected infection prevalence was high (15/20, 75%) in unfed adult Rhipicephalus appendiculatus ticks that fed as nymphs on an acutely-infected calf, but low (22/836, 2.6%) in unfed adult R. appendiculatus collected from field sites in Tanzania. Tick infection prevalence was comparable to that in previous studies that used salivary gland staining to detect T. parva infection in field-collected host-seeking ticks. Of 282 naturally-exposed zebu calves, seven had PCR-positive buffy coat samples prior to detection of Theileria spp. parasites in stained buffy coat cells or lymph node biopsies. Evidence of Theileria spp. infections was detected in stained smears of lymph node biopsies from 109 calves (38.6%) and buffy coat samples from 81 (28.7%), while buffy coat samples from 66 (23.4%) were PCR-positive for T. parva. Implications of these findings for the sensitivity and specificity of the PCR are discussed.

Serum amyloid A is a better early predictor of severity than C-reactive protein in acute pancreatitis

BACKGROUND

Serum amyloid A (SAA) is an early and sensitive marker of the extent of tissue trauma and inflammation. The aim of this study was to compare the early prognostic accuracy of SAA with that of serum C-reactive protein (CRP) in acute pancreatitis.

METHODS

In a prospective multicentre trial, plasma SAA and CRP levels were measured in patients with severe and mild acute pancreatitis, and in a control group with acute abdominal pain. Plasma samples were collected on admission and at 6-h intervals for 48 h, every 12 h between 48 and 72 h, then daily for 5 days. Plasma SAA was measured by a new enzyme-linked immunosorbent assay and CRP was measured by immunoturbidometry.

RESULTS

There were 137 patients with mild and 35 with severe acute pancreatitis, and 74 control patients. SAA levels were significantly higher in patients with severe acute pancreatitis than in those with mild acute pancreatitis, on admission, at 24 h or less after symptom onset, and subsequently. Whereas plasma CRP concentration was also significantly higher in patients with severe acute pancreatitis on admission, it failed to distinguish mild from severe acute pancreatitis until 30-36 h after symptom onset. SAA levels predicted severity (sensitivity 67 per cent, specificity 70 per cent, negative predictive value 89 per cent, mean(s.d.) area under curve 0.7(0.05)) significantly better than CRP (57 per cent, 60 per cent, 84 per cent, 0.59(0.06) respectively) on admission (P = 0.02) and at 24 h following symptom onset (area under curve 0.65(0.09) versus 0.58(0.09) respectively; P < or = 0.02).

CONCLUSION

Plasma SAA concentration is an early marker of severity in acute pancreatitis and is superior to CRP estimation on hospital admission and at 24 h or less after symptom onset. This study suggests that plasma SAA concentration is clinically useful, with the potential to replace CRP in the management of acute pancreatitis.

Serum amyloid A is a better early predictor of severity than C-reactive protein in acute pancreatitis

BACKGROUND

Serum amyloid A (SAA) is an early and sensitive marker of the extent of tissue trauma and inflammation. The aim of this study was to compare the early prognostic accuracy of SAA with that of serum C-reactive protein (CRP) in acute pancreatitis.

METHODS

In a prospective multicentre trial, plasma SAA and CRP levels were measured in patients with severe and mild acute pancreatitis, and in a control group with acute abdominal pain. Plasma samples were collected on admission and at 6-h intervals for 48 h, every 12 h between 48 and 72 h, then daily for 5 days. Plasma SAA was measured by a new enzyme-linked immunosorbent assay and CRP was measured by immunoturbidometry.

RESULTS

There were 137 patients with mild and 35 with severe acute pancreatitis, and 74 control patients. SAA levels were significantly higher in patients with severe acute pancreatitis than in those with mild acute pancreatitis, on admission, at 24 h or less after symptom onset, and subsequently. Whereas plasma CRP concentration was also significantly higher in patients with severe acute pancreatitis on admission, it failed to distinguish mild from severe acute pancreatitis until 30-36 h after symptom onset. SAA levels predicted severity (sensitivity 67 per cent, specificity 70 per cent, negative predictive value 89 per cent, mean(s.d.) area under curve 0.7(0.05)) significantly better than CRP (57 per cent, 60 per cent, 84 per cent, 0.59(0.06) respectively) on admission (P = 0.02) and at 24 h following symptom onset (area under curve 0.65(0.09) versus 0.58(0.09) respectively; P < or = 0.02).

CONCLUSION

Plasma SAA concentration is an early marker of severity in acute pancreatitis and is superior to CRP estimation on hospital admission and at 24 h or less after symptom onset. This study suggests that plasma SAA concentration is clinically useful, with the potential to replace CRP in the management of acute pancreatitis.

Bovine Staphylococcus aureus mastitis: strain recognition and dynamics of infection

Restriction enzyme fragmentation pattern (REFP) analysis was used to recognise Staphylococcus aureus strain variation in naturally occurring bovine subclinical mastitis. Multiple colony REFP analysis identified eight distinct strains of S. aureus in addition to the original strains A and B that were infused via the intramammary route, indicating that individual quarters of the udder may be colonised simultaneously by more than one strain of S. aureus. Examination of multiple colonies per milk sample may benefit bacterial strain recognition as an epidemiological tool in mastitis investigations. The dynamics of intramammary infection were determined using a novel double crossover experimental challenge. Quarters remained persistently infected for several weeks following challenge in all four cows, irrespective of the challenge strain. This indicated that no alteration of the original subclinical infection, including the possible induction of clearance of the quarters infected with S. aureus, or replacement of the original strain by the infused strain was induced by challenge. The persistent subclinical infection in all four animals supports previous reports on the chronicity of S. aureus intramammary infection in dairy cows.

Clinical perspective on apoptosis in the management of the BPH patient

BACKGROUND

Traditionally, alpha(1)-adrenoceptor (AR) antagonists have been assumed to produce clinical benefit by an exclusive action on the tone of the periurethral stromal smooth muscle. However, recent evidence has emerged of additional intra- and extraprostatic actions.

METHODS

This article attempts to put into clinical context the recently described effects of certain alpha(1)-AR on prostate cell dynamics (i.e., proliferation and apoptosis). RESULTS AND CONCLUSIONS There is good evidence that certain alpha(1)-AR antagonists, in addition to affecting stromal smooth muscle, have effects on prostatic apoptosis that contribute to the overall clinical profile. Furthermore, this is not a class effect and may be restricted to balanced quinazoline alpha blockers (BQABs), such as terazosin.

Oral health care needs of dependent older people: responsibilities of nurses and care staff

The population of older people as well as the number of dependent older people is steadily increasing. Those unable to live independently at home are being cared for in a range of settings and varying degrees of dependency means that many are unable to attend fully to their needs, one aspect of which is oral care. The fact that the oral and dental health of the UK population is generally improving, makes more emphatic the responsibilities of nurses and care staff in this area. This review of the literature reveals that oral health of older people in continuing care settings is generally inadequate and that nurses' and care staff's knowledge and practice of oral care for older people is variable. Inadequate oral care is identified as multifactorial, with implications for educators, policy makers, practitioners and researchers. The need to address oral care for nurses pre- and post-registration as well as adequate preparation for support workers is highlighted. Development of a robust oral assessment tool, as well as empirical investigation of the effectiveness of oral cleaning agents, equipment and techniques to inform standard setting is indicated, with monitoring of standards being imperative.

Benign cephalic histiocytosis with diabetes insipidus

Benign cephalic histiocytosis is a rare skin condition consisting of small tan papules on the face and upper trunk that is believed not to be associated with internal organ involvement. The infiltrating histiocytes are not Langerhans' cells (LCs). We report a 5-year-old girl who presented with diabetes insipidus 1 year after developing multiple small brown asymptomatic skin papules. Histologic examination revealed a non-LC histiocytic proliferation in the dermis without epidermal invasion. She had infiltration of the pituitary stalk on brain imaging. Diabetes insipidus has heretofore been associated with LC histiocytosis and xanthoma disseminatum but not benign cephalic histiocytosis.

Families, groups and clusters of local and health authorities: revised for authorities in 1999

This is the second of two articles describing the revision of The ONS classification of local and health authorities of Great Britain to take account of area changes in the 1990's. It presents local authorities in Great Britain as at April 1999 in terms of Families, Groups and Clusters, based on 37 socio-economic and demographic variables from the 1991 Census. Health authorities are presented in terms of Families and Groups only, based on the same variables. The previous article (in Population Trends 98) presented, for each local and health authority, up to four other authorities to which it is 'most similar'.