The National Institute for Health and Care Excellence information specialist development pathway: Developing the skills, knowledge and confidence to quality assure search strategies

Quality assurance (QA) is an important process in ensuring that systematic reviews and other evidence syntheses are supported by a high-quality search. This paper describes how the National Institute for Health and Care Excellence (NICE) in the UK established a development pathway to ensure its information specialists had the skills, knowledge and confidence to undertake search QA. The key component of the pathway is that it blends technical knowledge with interpersonal skills. The pathway develops technical skills in the early steps before using peer support activities to build confidence while undertaking a range of searches. QA is effective when the search lead communicates the contextual information that has influenced search development. QA is treated as a collaboration to get the right search for the review. The key requirements for search QA, alongside technical knowledge, are communication, collaboration and negotiation skills.

Ultraviolet exposure to the face in patients with xeroderma pigmentosum and healthy controls: applying a novel methodology to define photoprotection behaviour

BACKGROUND

In Xeroderma Pigmentosum (XP), the main means of preventing skin and eye cancers is extreme protection against ultraviolet radiation (UVR). Protection is most important for the face.

OBJECTIVES

We aimed to assess how well patients with XP adhere to medical advice to protect against UVR by objectively estimating the mean daily dose of UVR to the face.

METHODS

We objectively estimated the UVR dose to the face in 36 XP patients and 25 healthy individuals over 3 weeks in the summer. We used a new methodology which combined UVR dose measurements from a wrist-worn dosimeter with an activity diary record of face photoprotection behaviour for each 15 minute period spent outside. A protection factor was associated with each behaviour, and the data analysed using a negative binomial mixed-effects model.

RESULTS

The mean daily UVR dose (weighted for DNA damage capacity) to the face in the XP patients was 0.13 Standard Erythemal Doses (SED) (mean in healthy individuals = 0.51 SED). There was wide variation between patients (range <0.01 - 0.48 SED/day). Self-caring adult patients had a very similar UV dose to the face to cared-for patients (0.13 vs 0.12 SED/day) despite photoprotecting much more poorly when outside, because the self-caring adults were outside in daylight much less.

CONCLUSIONS

Photoprotection behaviour varies widely within the XP group indicating that non-adherence to photoprotection advice is a significant issue. Timing and duration of going outside are as important as photoprotective measures taken when outside, to determine the UVR exposure to the face. This new methodology will be of value in identifying the sources of UVR exposure in other conditions where facial UV exposure is a key outcome, particularly in patients with multiple non-melanoma skin cancers.

Microalgae cultivation for the treatment of anaerobically digested municipal centrate (ADMC) and anaerobically digested abattoir effluent (ADAE)

The successful cultivation of microalgae in wastewater establishes a waste to profit scenario as it combines treatment of a waste stream with production of valuable end-products. Here, growth and nutrient removal efficiency of three different locally isolated microalgal cultures (Chlorella sp., Scenedesmus sp., and a mixed consortium) cultivated in anaerobically digested municipal centrate (ADMC) and anaerobically digested abattoir effluent (ADAE) was evaluated. No significant differences (P > 0.05) in specific growth rate and biomass productivity were recorded between Chlorella monocultures and the mixed culture grown in both effluents. Scenedesmus sp. monocultures was found incapable of growth in both ADMC and ADAE throughout the cultivation period resulting in the collapse of cultures and no further measurements on the growth, biomass production and nutrient removal efficiency of this alga in both effluent. F_q´/F_m´ values which represent the immediate photo-physiological status of microalgae found to be negatively inhibited when Scenedesmus sp. was grown in both effluents throughout the cultivation period. F_q´/F_m´ values of Chlorella sp. monocultures and the mixed cultures recovered back to normal (≈0.6) after an initial drop. Ammonium removal rates was found to be significantly higher (≈2 folds) for Chlorella sp. monocultures grown in both ADMC and ADAE when compared to the mixed cultures. Nonetheless, no significant differences were observed in the removal of phosphate for both cultures in the different effluents. The total protein and carbohydrate content of the biomass produced was similar for both microalgae cultures grown using ADAE and ADMC. However, chlorophyll a and total carotenoids content were found to be higher (P < 0.05) for the cultures grown in ADAE than ADMC. Overall, Chlorella sp. monoculture was the most efficient option for treating both ADMC and ADAE while simultaneously generating protein rich biomass (up to 49%) that can be potentially exploited as aquaculture feedstock.

A global database of Holocene paleotemperature records

A comprehensive database of paleoclimate records is needed to place recent warming into the longer-term context of natural climate variability. We present a global compilation of quality-controlled, published, temperature-sensitive proxy records extending back 12,000 years through the Holocene. Data were compiled from 679 sites where time series cover at least 4000 years, are resolved at sub-millennial scale (median spacing of 400 years or finer) and have at least one age control point every 3000 years, with cut-off values slackened in data-sparse regions. The data derive from lake sediment (51%), marine sediment (31%), peat (11%), glacier ice (3%), and other natural archives. The database contains 1319 records, including 157 from the Southern Hemisphere. The multi-proxy database comprises paleotemperature time series based on ecological assemblages, as well as biophysical and geochemical indicators that reflect mean annual or seasonal temperatures, as encoded in the database. This database can be used to reconstruct the spatiotemporal evolution of Holocene temperature at global to regional scales, and is publicly available in Linked Paleo Data (LiPD) format.

An open-label, randomised controlled trial on the effectiveness of the Orve + wrap® versus Forced Air Warming in restoring normothermia in the postanaesthetic care unit

AIMS AND OBJECTIVES

To determine the clinical effectiveness and safety of the Orve + wrap® thermal blanket.

BACKGROUND

Inadvertent perioperative hypothermia is a common problem in postanaesthetic care units and can have significant effects on patients' postoperative morbidity. Despite its commercial availability, there is no clinical evidence on the effectiveness of Orve + wrap®.

DESIGN

A single centre prospective, open-label, noninferiority randomised controlled trial.

METHODS

Postoperative hypothermic (35.0-35.9°C) patients who had undergone elective surgery were randomised to receive either Orve + wrap® or Forced Air Warming during their PACU stay. Patient temperatures were recorded every 10 min using zero-heat-flux thermometry. This study is reported using CONSORT Extension checklist for noninferiority and equivalence trials.

RESULTS

Between December 2016-October 2018, 129 patients were randomised to receive either Orve + wrap® blanket (n = 65, 50.3%) or Forced Air Warming (n = 64, 49.7%). The mean 60-min postoperative temperature of patients receiving Orve + wrap® blanket was 36.2 and 36.3°C for the patients receiving Forced Air Warming. The predefined noninferiority margin of a mean difference in temperature of 0.3°C was not reached between the groups at 60 min. Additionally, there were no statistical differences between adverse event rates across these groups.

CONCLUSIONS

In the context of this study, warming patients with the Orve + wrap® was noninferior to Forced Air Warming. There were comparable rates of associated postoperative consequences of warming (shivering, hypotension, arrhythmias or surgical site infections), between the groups.

RELEVANCE TO CLINICAL PRACTICE

The Orve + wrap® potentially provides an alternative warming method to Forced Air Warming for patients requiring short-term postoperative warming. However, there are still a number of unknowns regarding the Orve + wrap® performance and further exploration is required.

The psychometric validation of the quality practical experience (QPE) instruments (nurses and student nurse) to evaluate clinical supervision of undergraduate student nurses

It is important to evaluate stakeholder feedback regarding any change to a clinical supervision model to maintain quality. The Quality Practical Experience (QPE) instruments offer both the nurse on the ward involved with supervising student learning and the student nurse the opportunity to evaluate their satisfaction with the supervision model. This paper reports on the evaluation of the construct validity and the reliability of the QPE instruments measuring nurse and nursing student satisfaction with the clinical supervision model. Methodological design for the reliability and validation of a measuring instrument. The nurse and the student QPE instruments were tested with convenience samples of 488 nurses and 1116 student nurses, respectively. Psychometric tests included internal reliability, test-retest reliability and factor analyses. Exploratory factor analysis for both QPEs supported a three-factor solution; the nurse QPE explained 48% and student nurse QPE 45% of variance. Internal reliability and test-retest reliability were stable over time (nurse QPE ICC = 0.82; student nurse QPE ICC = 0.71). Both QPE instruments were found to be valid and reliable. Feedback from all stakeholders involved with supporting student nurses during clinical placement is important.

Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes

BACKGROUND AND PURPOSE

Uncertainty persists regarding the safety and efficacy of endovascular therapy of M2 occlusions following IV tPA. We reviewed the impact of revascularization on clinical outcomes in 83 patients with M2 occlusions in the Interventional Management of Stroke III trial according to specific M1-M2 segment anatomic features.

MATERIALS AND METHODS

Perfusion of any M2 branch distinguished M2-versus-M1 occlusion. Prespecified modified TICI and arterial occlusive lesion revascularization and clinical mRS 0-2 end points at 90 days for endovascular therapy-treated M2 occlusions were analyzed. Post hoc analyses of the relationship of outcomes to multiple baseline angiographic M2 and M1 subgroup characteristics were performed.

RESULTS

Of 83 participants with M2 occlusion who underwent endovascular therapy, 41.0% achieved mRS 0-2 at 90 days, including 46.6% with modified TICI 2-3 reperfusion compared with 26.1% with modified TICI 0-1 reperfusion (risk difference, 20.6%; 95% CI, -1.4%-42.5%). mRS 0-2 outcome was associated with reperfusion for M2 trunk (n = 9) or M2 division (n = 42) occlusions, but not for M2 branch occlusions (n = 28). Of participants with trunk and division occlusions, 63.2% with modified TICI 2a and 42.9% with modified TICI 2b reperfusion achieved mRS 0-2 outcomes; mRS 0-2 outcomes for M2 trunk occlusions (33%) did not differ from distal (38.2%) and proximal (26.9%) M1 occlusions.

CONCLUSIONS

mRS 0-2 at 90 days was dependent on reperfusion for M2 trunk but not for M2 branch occlusions. For M2 division occlusions, good outcome with modified TICI 2b reperfusion did not differ from that in modified TICI 2a. M2 segment definition and occlusion location may contribute to differences in revascularization and good outcome between Interventional Management of Stroke III and other endovascular therapy studies.

Investigation of the epithelial to mesenchymal transition markers S100A4, vimentin and Snail1 in gastroesophageal junction tumors

Epithelial to mesenchymal transition (EMT) promotes tumor progression and invasion. As no study has focused on gastroesophageal junction (GEJ) tumors, the expression of three EMT-related proteins (S100A4, vimentin, and Snail1) was investigated with the aim of assessing their pathologic and prognostic significance. Resection specimens were obtained from 104 patients who underwent surgery for GEJ adenocarcinoma, without preoperative chemotherapy. Three tissue cores were obtained from each of the tumor body (TB), luminal surface (LS), and invasive edge (IE) to produce tissue microarrays, and immunohistochemical staining was performed. The microarrays were scored independently by two observers. The demographic and histopathologic details of the patients were collected. Overall positive expression was observed in 88 (S100A4, 85%), 16 (vimentin, 14%), and 92 (Snail1, 89%) tumors. Staining for S100 A4 was positive in 79 (76%) of TB, 69 (66%) of IE, and 69 (66%) of LS specimens. Staining for vimentin was positive in 7 (6%) of TB, 11 (11%) of IE, and 5 (5%) of LS specimens. Staining for Snail1 was positive in 83 (80%) of TB, 51 (49%) of IE, and 78 (75%) of LS specimens. Positive staining of TB for S100A4 (P = 0.04) and Snail1 at IE (P = 0.01) was associated with involvement of circumferential resection margins. Positive staining for S100A4 in the TB (P = 0.02) and LS (P = 0.01) was associated with poor 5-year overall survival. Vimentin had no statistically significant relationships with pathologic factors or outcome. The acquisition of mesenchymal protein S100A4 is associated with a poor prognosis in patients with GEJ tumors who undergo potentially curative surgery, and LS samples can be used to obtain prognostic information. Increased EMT-related protein expression (S100A4, Snail1) is associated with the involvement of circumferential resection margin.

A group-specific sequencing approach to investigate the presence of atypical human leucocyte antigen alleles

Accurate human leucocyte antigen (HLA) typing results are essential in determining the degree of compatibility between donor and recipient in both solid organ (SO) and hematopoietic stem cell (HSC) transplantation. Current HLA typing methodologies can generate ambiguous results which may need resolving. This group-specific sequencing approach allowed investigation into the presence of the low expressor HLA-A*24:02:01:02L allele and the rare HLA-A*02:64 allele in a SO transplant recipient and a HSC transplant recipient, respectively. Locus-specific amplification of HLA-A was performed. Exons 2 and 3 were sequenced in both directions followed by group-specific sequencing to resolve ambiguities. Hemizygous sequence data of intron 2 generated from the HLA-A*24 allele indicated the presence of the HLA-A*24:02:01:01 allele. HLA-A*02:64 was identified by sequencing the allele in isolation over exons 2 and 3 and allowed confirmation of this allele sequence with the IMGT/HLA database (Accession number AY297166). This approach is cost efficient and can be modified to sequence alleles at other HLA loci. It has also been adapted to characterize the novel HLA-DQB1*06:48 allele (Accession number HE647646) as well as the non-HLA gene, UGT2B17, making it a useful tool to augment existing typing methodologies.

So many filters, so little time: the development of a search filter appraisal checklist

OBJECTIVES

The authors developed a tool to assess the quality of search filters designed to retrieve records for studies with specific research designs (e.g., diagnostic studies).

METHODS

The UK InterTASC Information Specialists' Sub-Group (ISSG), a group of experienced health care information specialists, reviewed the literature to evaluate existing search filter appraisal tools and determined that existing tools were inadequate for their needs. The group held consensus meetings to develop a new filter appraisal tool consisting of a search filter appraisal checklist and a structured abstract. ISSG members tested the final checklist using three published search filters.

RESULTS

The detailed ISSG Search Filter Appraisal Checklist captures relevance criteria and methods used to develop and test search filters. The checklist includes categorical and descriptive responses and is accompanied by a structured abstract that provides a summary of key quality features of a filter.

DISCUSSION

The checklist is a comprehensive appraisal tool that can assist health sciences librarians and others in choosing search filters. The checklist reports filter design methods and search performance measures, such as sensitivity and precision. The checklist can also aid filter developers by indicating information on core methods that should be reported to help assess filter suitability. The generalizability of the checklist for non-methods filters remains to be explored.

Injury data in British Columbia: policy maker perspectives on knowledge transfer

Provincial and regional decision makers in the injury prevention field were interviewed in British Columbia (B.C.) to obtain their views about best processes for the transfer or dissemination of relevant data. These decision makers (n = 13) indicated that data should provide them with a holistic and comprehensive picture to support their decision processes. In addition, they felt information about injury types and rates should be linked backward to determinants or causes and forward to consequences or outcomes. This complete chain of data is needed for planning and evaluating health promotion interventions. It was also felt that data providers needed to devote more effort to fostering effective receptor capacity, so that injury prevention professionals will be better able to understand, interpret and apply the data. These findings can likely be generalized to other jurisdictions and policy areas, and offer additional insight into the practicalities of knowledge transfer and exchange in researcher/decision maker partnerships.

Twentieth-century survival from osteosarcoma in childhood. Trends from 1933 to 2004

We have reviewed the data from our regional Bone Tumour Registry on patients with osteosarcoma diagnosed between 1933 and 2004 in order to investigate the relationship between survival and changes in treatment. There were 184 patients with non-metastatic appendicular osteosarcoma diagnosed at the age of 18 or under. Survival was calculated using Kaplan-Meier curves, and multivariate analysis was performed using the Cox regression proportional hazards model. The five-year survival improved from 21% between 1933 and 1959, to 62% between 1990 and 1999. During this time, a multi-disciplinary organisation was gradually developed to manage treatment. The most significant variable affecting outcome was the date of diagnosis, with trends in improved survival mirroring the introduction of increasingly effective chemotherapy. Our experience suggests that the guidelines of the National Institute for Clinical Excellence on the minimum throughput of centres for treatment should be enforced flexibly in those that can demonstrate that their historical and contemporary results are comparable to those published nationally and internationally.

The National Epirubicin Adjuvant Trial (NEAT) and Scottish Cancer Trials Breast Group (SCTBG) br9601 randomized phase III adjuvant early breast cancer trials: The updated definitive joint analysis

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Background: NEAT and the SCTBG BR9601 trial address the role of Epirubicin (E) as an adjunct to CMF in adjuvant chemotherapy for women with early breast cancer (EBC). Methods: NEAT compared E (100mg/m2 x4cycles) followed by classical (c)CMF (x4cycles) with cCMF (x6cycles); BR9601 compared E (100mg/m2 × 4cycles) followed by iv dose modified CMF q3w (750:50:600 ×4cycles) with iv CMF (x8cycles). Eligibility was completely excised EBC, requiring adjuvant chemotherapy, and start of treatment <10 wks from surgery. Primary outcome measures were relapse-free-survival (RFS) and overall survival (OS). A joint efficacy analysis of NEAT (n=2,021) and BR9601 (n=370) triggered by planned 5-year median follow-up (FU) and estimated 800 RFS events and 600 deaths has 85% power to detect 5% two-sided differences. Results: In 2,391 eligible patients, characteristics were balanced across treatments: 72% node +ve; 59% <50 years old; 47% pre-menopausal; 58% tumours grade 3; 55% >2cms; 32% ER-ve, 50% ER+ve (18% NA). At a median FU of 6.2 yrs, 710 relapses or deaths without relapse and 570 deaths are observed. Despite lower than anticipated event rates in the control arm, these updated results confirm a highly significant benefit in favour of ECMF for both RFS (HR 0.75 (95%CI 0.64–0.87) p=0.0002) and OS (HR 0.74 (0.62–0.87) p=0.0004), independent of trial and prognostic factors. In 1458 NEAT patients (in whom data are available), 68% were to receive tamoxifen; chemotherapy scheduling data is available for 843, of whom 46% were declared concurrent and 54% sequential. In a non-pre-planned retrospective analysis, sequential tamoxifen shows a trend for advantage on RFS (HR 0.78 (0.59–1.02) p=0.06). We have amenorrhoea data on 598 NEAT and BR9601 pre-menopausal women, of whom 72% became amenorrhoeic by the end of chemotherapy. In this instance, developing amenorrhoea showed no advantage for RFS (HR 0.90 (0.65–1.24) or OS (HR 0.99 (0.68–1.44)). Conclusions: This updated definitive analysis adds to the Overview in respect of an anthracycline advantage and confirms ECMF as an established and effective standard adjuvant therapy for EBC.

[Table: see text]

The use of a hydrofibre dressing in fulminating necrotizing fasciitis

This article describes a case of necrotizing fasciitis in a 52-year-old man with previously undiagnosed diabetes. Treatment involved massive debridement and subsequent dressing of the open surgical wound. A modern hydrofibre dressing (Aquacel) was inserted intraoperatively and subsequently continued postoperatively. Wound healing occurred over 3 months and the patient was discharged with no disability. The dressing managed the exudate level and kept the wound moist. It also was well tolerated by the patient, was comfortable and easy for the nurses to remove and apply.

Botulinum toxin A and chronic low back pain: A randomized, double-blind study

OBJECTIVES

To investigate the efficacy of botulinum toxin A in chronic low back pain and associated disabilities.

METHODS

Thirty-one consecutive patients with chronic low back pain who met the inclusion criteria were studied: 15 received 200 units of botulinum toxin type A, 40 units/site at five lumbar paravertebral levels on the side of maximum discomfort, and 16 received normal saline. Each patient's baseline level of pain and degree of disability was documented using the visual analogue scale (VAS) and the Oswestry Low Back Pain Questionnaire (OLBPQ). The authors reevaluated the patients at 3 and 8 weeks (visual analogue scale) and at 8 weeks (OLBPQ).

RESULTS

At 3 weeks, 11 of 15 patients who received botulinum toxin (73.3%) had >50% pain relief vs four of 16 (25%) in the saline group (p = 0.012). At 8 weeks, nine of 15 (60%) in the botulinum toxin group and two of 16 (12.5%) in the saline group had relief (p = 0.009). Repeat OLBPQ at 8 weeks showed improvement in 10 of 15 (66.7%) in the botulinum toxin group vs three of 16 (18.8%) in the saline group (p = 0.011). No patient experienced side effects.

CONCLUSION

Paravertebral administration of botulinum toxin A in patients with chronic low back pain relieved pain and improved function at 3 and 8 weeks after treatment.

Southern Illinois University (SIU) sling-bone anchored semitendinosus

We describe a new type of pubovaginal sling that uses autologous fascia and minimizes the discomfort of harvest. The harvest is technically easy. The results are comparable to those of other slings previously described.

The impact of different response alternatives on responders' reporting of health-related behaviour in a postal survey

Previous experimental research in other topic areas has shown that the choice of response alternatives can influence respondents' reporting of the frequency of vaguely defined events and that the set of response alternatives is treated as information in the interpretation of the question. The aim of this study was to examine whether such affects would occur in the context of respondents reporting of health-related events using high and medium frequency closed format response categories, which might be used interchangeably by researchers. The study consisted of a postal survey of n = 518 patients aged > or = 18 years randomly selected from the patient list of a diabetes centre and who were equally and randomly allocated to one of three conditions (Condition A: high frequency response alternatives/horizontal orientation; condition B: medium frequency response alternatives/horizontal orientations; condition C: high frequency response alternatives/vertical orientation). Testing for the effect of response alternatives for the combined responses of five vaguely defined questions between conditions A and B was chi 2 = 5.5, p = 0.019, for the difference in proportions, indicating that overall, those respondents presented with response alternatives discriminating at medium frequency, reported significantly fewer target events than those presented with high frequency response alternatives. Testing for the effect of orientation of the combined question responses between conditions A and C, differences in proportions between conditions, did not reach statistical significance (p > 0.05). Findings from this and previous studies indicate that response alternatives provide information on the interpretation of vaguely defined questionnaire items and that their choice should not be left to intuition alone when designing questionnaire items.

Human resources. Getting even

A trust where a third of the workforce is a member of ethnic minority groups has set up a programme to enhance career advancement for this group. The programme aims to celebrate the achievements of ethnic minority staff and give them greater visibility within the organisation. Mentoring programmes and learning sets have been established with the support of senior.

Helicobacter pylori-selective antibacterials based on inhibition of pyrimidine biosynthesis

We report the discovery of a class of pyrazole-based compounds that are potent inhibitors of the dihydroorotate dehydrogenase of Helicobacter pylori but that do not inhibit the cognate enzymes from Gram-positive bacteria or humans. In culture these compounds inhibit the growth of H. pylori selectively, showing no effect on other Gram-negative or Gram-positive bacteria or human cell lines. These compounds represent the first examples of H. pylori-specific antibacterial agents. Cellular activity within this structural class appears to be due to dihydroorotate dehydrogenase inhibition. Minor structural changes that abrogate in vitro inhibition of the enzyme likewise eliminate cellular activity. Furthermore, the minimum inhibitory concentrations of these compounds increase upon addition of orotate to the culture medium in a concentration-dependent manner, consistent with dihydroorotate dehydrogenase inhibition as the mechanism of cellular inhibition. The data presented here suggest that targeted inhibition of de novo pyrimidine biosynthesis may be a valuable mechanism for the development of antimicrobial agents selective for H. pylori.

A comparison of hydrofibre and alginate dressings on open acute surgical wounds

This study aimed to compare the performance of a hydrofibre (Aquacel) and an alginate (Sorbsan) dressing on acute surgical wounds left to heal by secondary intention. A total of 100 patients were prospectively randomised pre-operatively to receive either the hydrofibre or the alginate dressing. Dressing performance was measured at operation, at 24 hours and seven days. Parameters measured included ease of: application and removal of the first dressing; re-application on the first postoperative day; and removal and re-application one week postoperatively. The hydrofibre dressing received higher scores for all of these categories. Patients in this group also experienced less pain (mild or none) on removal of the first dressing and at one week. However, these results did not achieve statistical significance, and should be seen as a trend. Nevertheless, the authors recommend the use of hydrofibre dressings on open acute surgical wounds.

Cost benefits of two dressings in the management of surgical wounds

In this prospective randomized controlled trial of the cost benefits of the choice of dressings in acute surgical wounds left to heal by secondary intention, patients had their wounds dressed with either a traditional dressing (ribbon gauze soaked in proflavine) or a modern hydrofibre dressing. Results showed that the hydrofibre dressing, although more expensive than the ribbon gauze, facilitated an earlier discharge from hospital (P = 0.001). The total cost of the patient episode was less in the hydrofibre group (P = 0.01). In an average UK health authority of 300,000 population, 100 bed days a year could be saved releasing an overall potential saving of 55,000 Pounds. A modern hydrofibre dressing allows more effective use of scarce hospital beds and precious financial resources, while still maintaining high quality patient care. It is important that clinical specialists and purchasers of health care should be aware of this clinical and cost-effective advance in the management of acute surgical wounds.

The role of a hydrofibre dressing in squamous cell carcinoma of the anal canal

This report describes an unusual presentation of squamous cell carcinoma of the anal canal involving the vagina; radical surgery resulted in a large cavity wound.

Isolation and species typing of Lyme borreliosis spirochaetes from UK patients with erythema migrans

Skin biopsies taken from UK cases of erythema migrans rash were cultured for Borrelia burgdorferi sensu lato. Reverse line blotting was used to type the infecting genospecies in PCR-positive cultures and biopsies. B. garinii or B. afzelii was identified in 56% (5/9) of biopsies/cultures tested. All patients were tested by conventional serology. PCR confirmed infection in two patients where serological testing failed to detect antibody.

Acute surgical wound care. 4: The importance of documentation

This article, the last in a series of four, discusses the importance of documenting wound care. Studies have shown that nurses do not document wound care as often, or as accurately, as they should in order to comply with the UKCC's (1998) Guidelines for Records and Record Keeping. Although some wound assessment charts have been published and are in use, there is still concern about the validity or reliability of some of these charts. Studies show that further research is necessary in order to validate the charts that are currently in use. An increase in litigation has placed more emphasis on accurate record keeping which shows, in detail, the wound care that is given to each patient. Patients also want to be more informed about their treatment, and this can be done through the use of clinical pathways or multidisciplinary documents. This article also discusses the factors that have to be considered when putting a wound care chart together and gives some examples of existing charts.

Acute surgical wound care. 3: Fitting the dressing to the wound

The third article in this series on surgical wound care discusses the types of dressings currently available, and selection of the correct dressing for a particular wound type. There is an abundance of information on the types of dressings available. Wound management for the individual patient must be decided using best evidence and taking into account patients' increased involvement in their care, new technology and the push to mobilize early, leading to early discharge from hospital. The nurse needs to have a good knowledge of the types of dressings available, the properties of individual dressings and a sound understanding of wound healing, in order to make an informed decision on wound management. General factors such as safety, comfort, pain management and convenience must be borne in mind when deciding which dressing is the best for individual patients, given that dressings now have to be cost-effective as well as clinically effective.

Self-reported body-rocking and other habits in college students

A brief survey of eight motor habits, including body-rocking, was administered to two large samples of college undergraduates. A subsample was retested to establish survey reliability and validity. Those indicating engagement in body-rocking were interviewed about their body-rocking. Two psychopathology instruments were administered. The general prevalence of self-described body-rocking was higher than expected, and there were positive correlations among the eight habits. Body-rocking was usually related to negative affect and usually reported to begin during the school years and later. Many individuals said other family members engaged in body-rocking. Psychopathology assessments indicated higher levels of general distress and higher prevalence of Generalized Anxiety Disorder in this subsample compared with a group not reporting body-rocking.

Two neuronal cell lines expressing the myelin basic protein gene display differences in their in vitro survival and in their response to glia

We have generated two conditionally immortalized neuronal cell lines from primary cultures of embryonic day 13 (E13) and postmitotic (postnatal day 0; P0) cortical neurons transformed with the temperature-sensitive SV-40 large-T antigen. Two clonal cell lines (CN1.4 from E13 cultures and SJ3.6 from P0 cultures) were isolated and stable maintained in vitro. Both cell lines expressed a number of neuronal markers such as the neurofilaments, glutamic acid decarboxylase 67, neuron-specific enolase, and the BG21 isoform of the myelin basic protein gene. At 34 degrees C, the CN1.4 cell line had elaborated short processes, whereas the SJ3.6 cell line produced long processes that formed a delicate network. When these cell lines were cultured at 39 degrees C, some of the cellular processes grew longer, adopting a more mature neuronal morphology. Interestingly, at 39 degrees C, the in vitro survival of these cell lines differed significantly. Whereas the survival of CN1.4 cell line was greatly unaffected, SJ3.6 cells died soon after they were cultured at 39 degrees C. The cell death of SJ3.6 cells was accompanied by fragmentation and condensation of DNA in their nuclei, indicative of an apoptotic event. Under these conditions, SJ3.6 showed an upregulation of the p75 receptor. When this cell line was cocultured with oligodendrocytes, astrocytes, or glial conditioned media (GCM), there was a marked increase in survival. In contrast, little effect of glial cells or GCM was observed on the CN1.4 cell line. These lines appear to be useful models to study neuronal-glial interactions in addition to neuronal cell death and the effects of glial factors that promote the survival of neurons.

Acute surgical wound care. 2: The wound healing process

The first article in this series on acute surgical wound care traced the history of surgical wound care from primitive dressings and techniques of closure used in the past to the present-day approaches. It also outlined the classification of acute surgical wounds (Vol 7(18): 1101-6). This second article describes the four stages of wound healing in acute surgical wounds, using clinical slides to illustrate the wound healing process. General factors, such as age, nutrition and medication, and local factors, including a moist environment, blood supply and wound infection, will be discussed to demonstrate their importance in promoting optimum wound healing.