Genetics of phenological development and implications for seed yield in lentil

Understanding phenology, its genetics and agronomic consequences, is critical for crop adaptation. Here we aim at (1) characterising lentil response to photoperiod with a focus on five loci: the lentil ELF3 ortholog Sn, two loci linked to clusters of lentil FT orthologs and two loci without candidates in chromosomes 2 and 5 (exp. 1: 36 lines, short and long day in phytotron); (2) establishing phenology-yield relationship (exp. 2: 25 lines, 11 field environments). A vintage perspective, where we quantify time trends in phenotype over three decades of breeding, links both experiments. Yield increased linearly from older to newer varieties at 29 kg ha-1 yr-1 or 1.5% yr-1, correlated negatively with flowering time in both winter- and summer-rainfall regimes, and decoupled from biomass in favourable environments. Time to flowering shortened from older to newer varieties at -0.56 % yr-1 in the field, and -0.42 % yr-1 (short day) and -0.99 % yr-1 (long day) in the phytotron. Early-flowering lines of diverse origin carried multiple early alleles for the five loci, indicating that at least some of these loci affect phenology additively. Current germplasm primarily features the early flowering haplotype for an FTb cluster region, hence the potential to increase phenological diversity with yield implications.

Antimicrobial stewardship knowledge, attitudes, and practices (KAP) among nurses

We performed a knowledge, attitudes, and practice (KAP) survey of bedside nurses to evaluate perceptions of antimicrobial use and aid in the design of nursing-based antimicrobial stewardship interventions. The survey highlighted discrepancies in knowledge and practice as well as opportunities to improve communication with nursing colleagues.

181. Impact of Rapid Diagnostic Technology on Patients with Candidemia

Background

Candida spp. are the fourth most common cause of bloodstream infections (BSI) in the United States and have an associated mortality rate of 19-40.5%. Mortality rates are further impacted by delay in time to adequate antifungal therapy, historically due to delayed time to identification on culture. The utilization of rapid diagnostic technology (RDT) has been effective in timely identification of bacterial pathogens causing BSI, but RDT for fungal organisms has demonstrated mixed results. At AdventHealth Central Florida Division South (CFD-S), pharmacists provide 24-hour coverage for real-time notification of all positive blood culture results. The objective of this study was to evaluate the clinical impact of the GenMark ePlex Blood Culture Identification Panels (BCID) fungal pathogen (FP) panel paired with 24/7, pharmacist-driven response in patients with candidemia. 

Methods

This multi-site, pre/post, retrospective chart review included adult patients admitted to CFD-S with at least one positive blood culture with Candida spp. from June 2019 through May 2020 (pre-RDT), and August 2020 through July 2021 (post-RDT). Patients receiving systemic antifungal prophylaxis, with known candidiasis at time of index RDT result, or who discharged prior to culture positivity were excluded. The primary outcome was time to effective antifungal therapy in patients with candidemia.

Results

A total of 200 patients were included in the study (100 pre-RDT and 100 post-RDT). Overall, patients had a median age of 61 years and 50% were male. Patient characteristics are summarized in Table 1; median APACHEII score differed by three points (13.5 vs. 16.5). Time to effective therapy was similar between groups (39.8 vs. 38.5 hours, p=0.217). There was no difference in secondary outcomes (Table 2) other than ICU length of stay (2.5 vs. 6.0 days, p=0.033) and all-cause in-hospital mortality (15% vs. 30%, p=0.011).

Conclusion

Pharmacist-driven, real-time response to RDT did not significantly impact time to effective antifungal therapy in patients with candidemia. Higher rate of in-hospital mortality was likely a reflection of increased severity of illness in the post-RDT group.

Disclosures

Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board.

1005. Financial and clinical impact of ceftolozane/tazobactam global recall on the treatment of multi-drug resistant Pseudomonas in a large health system

Background

In December 2020, ceftolozane/tazobactam (CT) was voluntarily recalled due to failed sterility tests. With this recall, clinicians were forced to utilize alternatives for multi-drug resistant (MDR) Pseudomonas (PSA) infections until CT returned in late December, 2021. While many studies have examined the impact of medication shortages, few have evaluated the impact of antimicrobial shortages. We evaluated the impact of the CT recall by assessing cost, clinical outcomes, and utilization of novel alternative agents.

Methods

This multi-site retrospective cohort study compared patients treated for MDR PSA prior to the CT recall (Jan-Jul 2020) to patients treated during the CT recall (Jan-Jul 2021) across seven AdventHealth Central Florida (AHCF) adult hospitals. The primary outcome was percentage of patients treated with novel therapies (CT, ceftazidime/avibactam, or cefiderocol). Secondary outcomes included length of therapy (LOT), inpatient mortality, 30-day readmissions, length of say (LOS), pharmacy expenditures, and average cost per case.

Results

A total of 203 patients with MDR PSA were evaluated: 100 in the pre-recall cohort and 103 in the post-recall cohort. The majority (58%) of patients were male with an average age of 64 years. The most common source of infection in both cohorts was pneumonia, followed by complicated urinary tract infection. Significantly more patients were treated with novel agents as definitive therapy in the post-recall cohort (65% vs. 29%, p< 0.0001). Average LOT for all anti-PSA therapy was 12 days in the pre-recall cohort compared to 14 days in the post-recall cohort (p=0.1753). Inpatient mortality and 30-day readmissions were not statistically different between groups. Hospital LOS was significantly different between the two groups (18 days vs. 25 days, p=0.006). Significantly higher pharmacy expenditures were found in the post recall cohort (Figure 1) and the average cost per case was significantly higher in the post-recall cohort ($125,254 vs. $62,249). Figure 1:Pharmacy Expenditures for Novel Agents

Novel agents: cefiderocol, ceftazidime/avibactam, ceftolozane/tazobactam

Conclusion

The CT recall had a significant impact on both economic and clinical outcomes, particularly increased length of stay, length of therapy, and cost to both the patient and health system. Higher utilization of novel agents is concerning given rising rates of PSA resistance.

Disclosures

Amy L. Carr, PharmD, BCIDP, Shionogi: Advisory Board.

919. Let’s GO PO: Impact of Monthly Feedback on a Longitudinal Intravenous to Oral Antimicrobial Conversion Initiative

Background

Timely conversion of antimicrobials from intravenous (IV) to oral (PO) route has been shown to decrease costs and length of stay (LOS) without compromising safety and efficacy of therapy. Use of oral antimicrobials may additionally prevent complications related to IV catheters, such as infection, emboli, and patient discomfort. An approved IV to PO policy allowed pharmacists to convert orders for fourteen included antimicrobials and eligible patients at time of order verification.

Methods

This single-center, retrospective, comparative study was conducted at AdventHealth Orlando, a 1,368-bed community teaching hospital in central Florida. In November 2020, six clinical pharmacist teams began receiving monthly feedback on IV to PO conversion rates in the form of a RePOrt Card, containing IV to PO conversion rates compared to other clinical teams, individual antimicrobial conversion rates, and comparison to prior team progress (Figure 1). RePOrt Cards were provided through October 2021. This study compared pre-intervention days of therapy (DOTs) of antimicrobials from November 2019-October 2020 to post-intervention DOTs from November 2020 to March 2022. The primary objective of this study was to assess the impact of monthly, team-based feedback on percentage of antimicrobials administered orally during a pharmacist-driven IV to PO stewardship initiative. Figure 1

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in Non-Hospital Care Settings in 2021

The scope of antimicrobial stewardship programs has expanded beyond the acute hospital setting. The need to optimize antimicrobial use in emergency departments, urgent, primary, and specialty care clinics, nursing homes, and long-term care facilities prompted the development of core elements of stewardship programs in these settings. Identifying the most innovative and well-designed stewardship literature in these novel stewardship areas can be challenging. The Southeastern Research Group Endeavor (SERGE-45) network evaluated antimicrobial stewardship-related, peer-reviewed literature published in 2021 that detailed actionable interventions specific to the non-hospital setting. The top 13 publications were summarized following identification using a modified Delphi technique. This article highlights the selected interventions and may serve as a key resource for expansion of antimicrobial stewardship programs beyond the acute hospital setting.

A follow-up on quantitative and qualitative olfactory dysfunction and other symptoms in patients recovering from COVID-19 smell loss

BACKGROUND

Sudden smell loss is a specific early symptom of COVID-19, which, prior to the emergence of Omicron, had estimated prevalence of ~40% to 75%. Chemosensory impairments affect physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. The aim of this cohort study was to characterize smell function and recovery up to 11 months post COVID-19 infection.

METHODS

This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial survey (S1) about respiratory symptoms, chemosensory function and COVID-19 diagnosis between April and September 2020, were invited to complete a follow-up survey (S2). Between September 2020 and February 2021, 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness.

RESULTS

At follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID illness. The ability to smell during COVID-19 was rated slightly lower by those who did not eventually recover their pre-illness ability to smell at S2.

CONCLUSIONS

While smell ability improves for many individuals who lost it during acute COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is associated with broader persistent symptoms of COVID-19, and may last for many months following acute COVID-19. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that even conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.

Renin Angiotensin Aldosterone System Antagonism in 2019 Novel Coronavirus Acute Lung Injury

It has been established that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme 2 (ACE2), a membrane-bound regulatory peptide, for host cell entry. Renin-angiotensin-aldosterone system (RAAS) inhibitors have been reported to increase ACE2 in type 2 pneumocyte pulmonary tissue. Controversy exists for the continuation of ACE inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists in the current pandemic. ACE2 serves as a regulatory enzyme in maintaining homeostasis between proinflammatory angiotensin II and anti-inflammatory angiotensin 1,7 peptides. Derangements in these peptides are associated with cardiovascular disease and are implicated in the progression of acute respiratory distress syndrome. Augmentation of the ACE2/Ang 1,7 axis represents a critical target in the supportive management of coronavirus disease 2019–associated lung disease. Observational data describing the use of RAAS inhibitors in the setting of SARS-CoV-2 have not borne signals of harm to date. However, equipoise persists, requiring an analysis of novel agents including recombinant human-ACE2 and existing RAAS inhibitors while balancing ongoing controversies associated with increased coronavirus infectivity and virulence.

A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2020

The number of articles related to antimicrobial stewardship published each year has increased significantly over the last decade. Keeping up with the literature, particularly the most innovative, well-designed, or applicable to one’s own practice area, can be challenging. The Southeastern Research Group Endeavor (SERGE-45) network reviewed antimicrobial stewardship–related, peer-reviewed literature from 2020 that detailed actionable interventions. The top 13 publications were summarized following identification using a modified Delphi technique. This article highlights the selected interventions and may serve as a key resource for teaching and training, and to identify novel or optimized stewardship opportunities within one’s institution.

Unrepresented community odour impact: Improving engagement strategies

Complaints for odour causing industry continue to increase in numeracy and severity. One assessment approach using Gas Chromatography-Mass Spectrometry/Olfactometry (GC-MS/O), has been used primarily to identify priority odourants within a standardised panel. We investigated the variation of response between participants of average and high olfactory sensitivity, and discovered that current GC-MS/O methodologies do not represent the entirety of community odour impact. Based on these results we constructed a Biosolids Processing Odour Wheel followed by a Community Odour Wheel for use by untrained community members and site operators. By using the information gathered from this research, as well as odour testing workshops for a wastewater treatment plant's staff and community surrounding the facility, we established a communicative system, which was subsequently incorporated into an online dynamic odour observation platform. This platform provides the WWTP with meaningful information from the community, as well as a common language for which to discuss environmental malodour with all stakeholders.

Survey of the effect of odour impact on communities

In the context of environmental malodour, surveys are valuable as they allow for the relatively detailed analysis of multiple factors pertaining to odour perception and subsequent reaction. However, the causes for an individual to experience odour impact while a neighbour will not are still not understood. The goal of this current survey design was to consolidate varying research paths for surveys within the environmental odour research space. This survey investigated the area of effect for wastewater treatment plants by using stratified random sampling techniques that radiated from the industrial areas. Additionally, this survey provided a "non-alerted" response to environmental malodour that represents a step forward for ecological validity. We found a small number of items relating to odour annoyance and home ownership that can be used in order to predict odour impact for individual community members. However, we also did not find any relationship with odour impact and perceived control. This survey design and analysis reconciles the varied approaches towards community surveys administered in prior literature, as well as providing information to improve future community engagement policies.

The impact of malodour on communities: a review of assessment techniques

Malodours remain the biggest source of complaints regarding environmental issues. This factor is likely to increase, as the urban development steadily encroaches into areas that have malodourous emitting industries (such as wastewater and waste management operations and intensive livestock practices), and has the potential to be both time and fiscally expensive. Despite the enormous amount of research involved in odour detection and abatement, as well as the creation of several distinct methodologies, there has yet been no definitive procedure to evaluate odour impact on communities, as well as community response. This paper is a review of the current methods that explore this problem, as well as a précis of this research field's goals and challenges. The first aim of this review is to illustrate the dichotomy between regulatory-established procedures, such as panellist testing, and methods that are centred around producing a more comprehensive explanation of factors that influence an odour's impact on a community or individual. In that regard, we have addressed several predominant paradigms of inquiry for this field: analytical methods, panellist testing, qualitative research, and survey methods, with associated variants. Secondly, the challenges of measuring and monitoring community impact are discussed. While the quantification of odorants is crucial to appreciating impact, individual-based modifiers of perception have an enormous scope for which to shape the effect of those odours. Perceptual differences are also likely the most dominant variables that influence the elicited behaviour of individuals who have experienced malodour exposure.

Evaluation of smoking on olfactory thresholds of phenyl ethyl alcohol and n-butanol

The effect of smoking on the sense of smell remains inconclusive. Previous research suggests that this is due to idiosyncratic acuity dependent on the odorants used in testing. Specifically, it appears that smokers have reduced olfactory acuity to odorants found within cigarettes compared with odorants not within cigarettes. Given that some of these odorants are used in tomography and magnetic resonance imaging, an in-depth understanding of this phenomenon in smoking individuals is crucial. This study assesses the variation of olfactory thresholds in smokers based on selective impairment to two odors commonly used in olfactory testing - n-butanol and phenyl ethyl alcohol (PEA). We presented to 46 participants an 18 step, forced choice, three choice ascending staircase method sniff bottle threshold test using n-butanol and PEA. PEA is present in cigarettes while n-butanol is not. Therefore n-butanol is used as a covariate to control for variance explained by any general olfactory dysfunction. Using this method, we can focus solely on selective impairment. We discovered that n-butanol threshold scores were significantly different between smokers and nonsmokers. In addition, after using n-butanol as covariate, phenyl ethyl alcohol scores remained significantly different between groups. This data suggests that there is an extended impairment to odors within tobacco and this may explain a cause of the inconclusiveness of past research.

Bitter taste markers explain variability in vegetable sweetness, bitterness, and intake

Intake of vegetables falls short of recommendations to lower risk of chronic diseases. Most research addresses bitterness as a sensory deterrent to consuming vegetables. We examined bitter and sweet sensations from vegetables as mediators of vegetable preference and intake as well as how these tastes vary with markers of genetic variation in taste (3.2 mM 6-n-propylthiouracil bitterness) and taste pathology (1.0 mM quinine bitterness, chorda tympani nerve relative to whole mouth). Seventy-one females and 39 males (18-60 years) reported prototypical tastes from and preference for Brussels sprouts, kale and asparagus as well as servings of vegetables consumed, excluding salad and potatoes. Intensity and hedonic ratings were made with the general Labeled Magnitude Scale. Data were analyzed with multiple linear regression and structural equation modeling. Vegetable sweetness and bitterness were independent predictors of more or less preference for sampled vegetables and vegetable intake, respectively. Those who taste PROP as most bitter also tasted the vegetables as most bitter and least sweet. The spatial pattern of quinine bitterness, suggestive of insult to chorda tympani taste fibers, was associated with less bitterness and sweetness from vegetables. Via structural equation modeling, PROP best explained variability in vegetable preference and intake via vegetable bitterness whereas the quinine marker explained variability in vegetable preference and intake via vegetable bitterness and sweetness. In summary, bitterness and sweetness of sampled vegetables varied by taste genetic and taste function markers, which explained differences in preference for vegetables tasted in the laboratory as well as overall vegetable intake outside the laboratory.

Extracellular secretion of Aspergillus phytase from Arabidopsis roots enables plants to obtain phosphorus from phytate

Phosphorus (P) deficiency in soil is a major constraint for agricultural production worldwide. Despite this, most soils contain significant amounts of total soil P that occurs in inorganic and organic fractions and accumulates with phosphorus fertilization. A major component of soil organic phosphorus occurs as phytate. We show that when grown in agar under sterile conditions, Arabidopsis thaliana plants are able to obtain phosphorus from a range of organic phosphorus substrates that would be expected to occur in soil, but have only limited ability to obtain phosphorus directly from phytate. In wild-type plants, phytase constituted less than 0.8% of the total acid phosphomonoesterase activity of root extracts and was not detectable as an extracellular enzyme. By comparison, the growth and phosphorus nutrition of Arabidopsis plants supplied with phytate was improved significantly when the phytase gene (phyA) from Aspergillus niger was introduced. The Aspergillus phytase was only effective when secreted as an extracellular enzyme by inclusion of the signal peptide sequence from the carrot extensin (ex) gene. A 20-fold increase in total root phytase activity in transgenic lines expressing ex::phyA resulted in improved phosphorus nutrition, such that the growth and phosphorus content of the plants was equivalent to control plants supplied with inorganic phosphate. These results show that extracellular phytase activity of plant roots is a significant factor in the utilization of phosphorus from phytate and indicate that opportunity exists for using gene technology to improve the ability of plants to utilize accumulated forms of soil organic phosphorus.

Sonic hedgehog signaling is required during the appearance of spinal cord oligodendrocyte precursors

Spinal cord oligodendrocyte precursors arise in the ventral ventricular zone as a result of local signals. Ectopic oligodendrocyte precursors can be induced by sonic hedgehog (Shh) in explants of chick dorsal spinal cord over an extended developmental period. The role of Shh during normal oligodendrocyte development is, however, unclear. Here we demonstrate that Shh is localized to the ventral spinal cord immediately prior to, and during the appearance of oligodendrocyte precursors. Continued expression of Shh is required for the appearance of spinal cord oligodendrocyte precursors as neutralization of Shh signaling both in vivo and in vitro during a defined developmental period blocked their emergence. The inhibition of oligodendrocyte precursor emergence in the absence of Shh signaling was not the result of inhibiting precursor cell proliferation, and the neutralization of Shh signaling after the emergence of oligodendrocyte precursors had no effect on the appearance of additional cells or their subsequent differentiation. Similar concentrations of Shh induce motor neurons and oligodendrocytes in dorsal spinal cord explants. However, in explants from early embryos the motor neuron lineage is preferentially expanded while in explants from older embryos the oligodendrocyte lineage is preferentially expanded.

Ketorolac vs chlorpromazine in the treatment of acute migraine without aura. A prospective, randomized, double-blind trial

BACKGROUND

Many treatments for acute migraine exist. Chlorpromazine is effective but has serious side effects. Ketorolac has only rare side effects.

OBJECTIVE

To compare intramuscular ketorolac troinethamine with intravenous chlorpromazine hydrochloride in treating acute migraine.

METHODS

We performed a prospective, randomized, double-blind trial comparing the clinical effectiveness of 60 mg of intramuscular ketorolac tromethamine with 25 mg of intravenous chlorpromazine hydrochloride in patients with acute migraine headache seen in the emergency department. Pain intensity, quantitated using the Wong-Baker Faces Rating Scale, was measured every 30 minutes for 2 hours in the emergency department. Patients returned pain scores at 6, 12, 24, and 48 hours by mail.

RESULTS

Fifteen patients were entered into each treatment arm. No differences were seen between the mean pain scores or the mean change in pain scores. The ketorolac group mean (+/- SEM) pain score decreased from 4.07 +/- 0.18 to 0.73 +/- 0.3 in 2 hours. The chlorpromazine group pain score decreased from 4.47 +/- 0.17 to 0.87 +/- 0.4. Two of the 3 nonresponders responded to the alternate group's treatment. No side effects were seen.

CONCLUSIONS

Using 60 mg of intramuscular ketorolac tromethamine is as effective as 25 mg of intravenous chlorpromazine hydrochloride in the treatment of acute migraine headache. Patients who do not respond to one of these medications may respond to the other.

A comparison of three gastric lavage methods using the radionuclide gastric emptying study

To determine the percentage of liquid gastric contents experimentally removable by available orogastric lavage systems, five healthy young volunteers were asked to ingest 1 mCi of liquid technicium-99m diethylenetriaminepentaacetic acid (Tc99m-DTPA) mixed with 50 ml tap water. Five minutes afterwards, the radionuclide was lavaged using one of three different techniques-a single syringe method, a closed gravity drainage system, and a closed double syringe method--while continuous radioisotope camera images were taken. Control images, with no lavage performed, were also taken. All of the orogastric lavage methods removed a mean of between 80% and 85% of the stomach contents. The double syringe method was the quickest, while the single syringe method was least tolerated. When compared with control, none of the lavage techniques pushed gastric contents into the duodenum. Thus, in terms of amount of liquid gastric contents removed, there was no one method that removed more than the others. Caution should be exercised in assuming that 80-85% of a liquid gastric ingestion can be removed by lavage in the uncontrolled clinical setting. The use of any orogastric lavage for ingestion evacuation should be undertaken knowing that it is a morbid procedure and usually not necessary.

Randomized double-blind comparison of the analgesic efficacy of intramuscular ketorolac and oral indomethacin in the treatment of acute gouty arthritis

STUDY OBJECTIVE

To compare the analgesic effect of IM ketorolac tromethamine with that of oral indomethacin in the treatment of acute gouty arthritis.

DESIGN

Prospective, randomized, double-blind, controlled, parallel group clinical trial.

SETTING

Two urban emergency departments.

PARTICIPANTS

Twenty consecutive patients who presented to the ED with acute gout.

INTERVENTIONS

Each patient was randomly assigned to receive in the ED (1) 60 mg of IM ketorolac and oral placebo or (2) 50 mg of oral indomethacin and IM placebo. The patients rated the intensity of their pain on a Wong-Baker pain scale (which runs from 0 to 5) before treatment and 30, 60, 90, and 120 minutes after treatment. All the patients were discharged with instructions to take oral indomethacin and to complete pain score cards at home at 6, 12, and 24 hours.

RESULTS

The 10 patients in each group were similar with regard to age, sex, race, and initial mean pain score. After 2 hours, the mean pain scores (+/- SD) for the ketorolac group had decreased from 4.5 +/- .71 to 1.4 +/- 1.43 (P < .05), and the mean score for the indomethacin group had decreased from 4.4 +/- .70 to 1.5 +/- 1.18 (P < .05). The difference between the two groups was not significant. At 6 hours, there was some pain rebound in the ketorolac group.

CONCLUSION

IM ketorolac and oral indomethacin are similar in the relief of the pain of acute gouty arthritis in the ED.

Research utilization: the development of a preoperative teaching protocol

A research-based preoperative teaching protocol was designed for use with surgical patients at a rural midwestern hospital. A strong research base supported the development of a protocol which included an individual teaching plan adapted to the patient's fear/anxiety level. A practice-level model was designed to guide the staff nurse through the preoperative teaching process. Expected outcomes were established and an evaluation tool developed. This research utilization project improved patient outcomes and benefitted nurses and the organization.

Correlations between scores on the Wechsler Intelligence Scale for Children-III and the General Purpose Abbreviated Battery of the Stanford-Binet IV

Estimations of some relationships among scores on the "General Purpose Abbreviated Battery" of the Stanford-Binet: Fourth Edition and the Wechsler Intelligence Scale for Children-III were based on the responses of 14 boys and 18 girls enrolled in Grades 3, 4, and 5 and who took both tests. Of 13 Pearson correlations between the Binet IV composite score and the Wechsler subtest scores and IQs 12 were statistically significant (rs = .45 to .74). The new Wechsler scale appears to be a valid instrument for the 32 children (8-8 to 11-11) who were tested.

Use of research based knowledge in clinical practice

The authors describe three research utilization projects that used a knowledge-driven approach to nursing practice. The activities involved in developing and implementing these research utilization projects included: (1) preparing nurses to read, critique, and use research; (2) identifying and reviewing research studies in a common area to develop a research base; (3) transforming the research based knowledge into a protocol to be used in the clinical area by nurses caring for patients; and (4) evaluating the protocol to see whether it is being implemented as expected and whether it is producing the predicted results. This practical utilization is discussed and illustrated in a systems theory model.

Normal changes in aging and nursing implications of drug therapy

Safe and effective pharmacotherapy of the elderly goes far beyond the mechanical safeguards for administering the right drug to the right patient at the right time. A broad knowledge of cell membrane dynamics as reviewed here and how they are related to the processes of drug disposition provide baseline data used for monitoring drug action and drug-user responses. However, each period of the life span has its own particular characteristics that may qualify expected drug response unless standard drug regimens area adjusted and individualized. Normal changes in body structure and function imposed by the aging process require special attention, for while the patient may be in a steady state, age-related reduction in range of homeostatic processes leads to varied levels of drug response and changed susceptibility to drug reactions. Appreciation of these qualifiers of pharmacotherapy can help to reduce the high incidence of drug-related illnesses in the aged.