A survey of the use of self-acupuncture in pain clinics--a safe way to meet increasing demand?

An acupuncture service is well established within a pain clinic in Nottingham, England, and is now unable to meet the increasing demand for treatment despite recent expansion. Patients used to be offered training in self-acupuncture. This was withdrawn because of safety concerns, but is being considered again as a way of meeting the demand.

An exploration of the factors that influence the implementation of evidence into practice.

Background: The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process.

What counts as evidence in evidence-based practice?

Background: Considerable financial and philosophical effort has been expended on the evidence-based practice agenda. Whilst few would disagree with the notion of delivering care based on information about what works, there remain significant challenges about what evidence is, and thus how practitioners use it in decision-making in the reality of clinical practice.

Aim: This paper continues the debate about the nature of evidence and argues for the use of a broader evidence base in the implementation of patient-centred care.

Patient-controlled ropivacaine analgesia after arthroscopic subacromial decompression.

Purpose: To evaluate the efficacy of a subacromial patient-controlled analgesia (PCA) infusion of 0.2% ropivacaine versus saline for postoperative pain control following arthroscopic shoulder surgery.

Type Of Study: Double-blind prospective randomized study.

Heat insoluble cryoglobulin associated with gangrene in multiple myeloma.

Cryoglobulins are immunoglobulins that have tendency to precipitate in temperatures below 37 degrees C and dissolve with rewarming. Monoclonal cryoglobulins are usually associated with a distinct hematological disorder and often are asymptomatic. Heat insoluble cryoglobulin has been described with Sjogren's syndrome and glomerulonephritis but, not with multiple myeloma.

Simplifying collection of corneal specimens in cases of suspected bacterial keratitis.

Identification of the causative organisms in suspected bacterial keratitis traditionally involves collecting multiple corneal scrapes, which are plated directly onto different solid agar culture media. Difficulties have been reported with this practice, so the development of a simpler diagnostic method in suspected bacterial keratitis would be useful. It is unclear whether a single corneal scrape sent to the microbiology laboratory in a liquid transport culture medium (indirect method) is as reliable for the diagnosis of bacterial keratitis as inoculation of multiple scrapes directly onto agar plates (direct method).

Methods for evaluation of small scale quality improvement projects.

Evaluation is an integral component of quality improvement and there is much to be learned from the evaluation of small scale quality improvement initiatives at a local level. This type of evaluation is useful for a number of different reasons including monitoring the impact of local projects, identifying and dealing with issues as they arise within a project, comparing local projects to draw lessons, and collecting more detailed information as part of a bigger evaluation project. Focused audits and developmental studies can be used for evaluation within projects, while methods such as multiple case studies and process evaluations can be used to draw generalised lessons from local experiences and to provide examples of successful projects.

Impact of normal-phase gradient elution in chiral chromatography: a novel, robust, efficient and rapid chiral screening procedure.

Novel normal-phase gradient systems have been employed for fast high-throughput chiral analyses of Discovery compounds in our research laboratories in Eli Lilly and Company. In this report, we describe an automated screening approach based on gradient elution, in order to achieve accurate enantiomeric excess determinations, and chiral separations when needed, in the shortest possible timeframe. Baseline resolution of enantiomers has been obtained for over 85% of the samples so tested.

Progress of unit based quality improvement: an evaluation of a support strategy.

Objective: To evaluate a strategy for supporting nurses to work with quality improvement (QI).

Design: Post-intervention evaluation. Study participants and intervention: 240 nurses participated in a uniformly designed 4 day basic training course in applying a model for QI.

Ingredients for change: revisiting a conceptual framework.

Finding ways to deliver care based on the best possible evidence remains an ongoing challenge. Further theoretical developments of a conceptual framework are presented which influence the uptake of evidence into practice. A concept analysis has been conducted on the key elements of the framework--evidence, context, and facilitation--leading to refinement of the framework.

Implementing evidence-based practice in clinical situations.

Many nurses in a variety of clinical settings are facing the challenges posed by incorporating evidence-based practice in health care. Some of the steps involved in implementing evidence-based care in clinical practice are discussed and a two-step framework to assist practitioners in implementing evidence-based practice is outlined. Factors such as the relevance of specific guidelines or research, generalisability of research findings, the strength of the evidence relative to the risks and benefits of treatment, and patient preferences are discussed in terms of evidence-based decision making.

Getting evidence into practice: ingredients for change.

Mounting pressure is being exerted to ensure that the delivery of care is evidence-based and clinically effective. However, the challenge this presents to practitioners is complex. The authors propose that successful implementation of evidence into practice is a function of three elements: the nature of the evidence; the context in which the change is to take place; and the way the process is managed.

The implementation of clinical practice guidelines for venous leg ulcers.

Since publishing its guidelines on the management of venous leg ulcers last year, the RCN has worked steadily to implement and audit both the guidelines, and their impact.

Getting evidence into practice: the meaning of 'context'.

Aim Of Paper: This paper presents the findings of a concept analysis of 'context' in relation to the successful implementation of evidence into practice.

Background: In 1998, a conceptual framework was developed that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice [Kitson A., Harvey G.

Getting evidence into practice: the role and function of facilitation.

Aim Of Paper: This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice.

Background: In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context.

National guidelines for Swedish neonatal nursing care: evaluation of clinical application.

Objective: To evaluate the clinical application of national guidelines for neonatal nursing.

Design: Questionnaire survey.

Setting: Thirty-nine neonatal care units in Sweden.

Towards practice development--a vision in reality or a reality without vision?

This paper describes the development of a conceptual framework for practice development. Drawing on the authors' combined experiences of facilitating developments in practice, a conceptual framework is proposed. It is argued that much practice development in health care today lacks a systematic approach and is often undertaken by individual practitioners who are poorly prepared for their roles.

Serologic abnormalities in systemic sclerosis.

Recent evidence has confirmed that sera from most systemic sclerosis (SSc) patients contain one of three mutually exclusive, SSc-associated autoantibodies (anti-RNA polymerase III, anti-topoisomerase I, or anti-centromere antibodies). Each is associated with the presence of particular clinical features and certain human lymphocyte antigen (HLA) alleles. Based on the available data the most likely model is for the existence of three distinct disease processes, each with certain key pathologic features.

Multiplex polymerase chain reaction for the simultaneous detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia psittaci in respiratory samples.

Aims: To develop a multiplex polymerase chain reaction (PCR) for the simultaneous detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia psittaci in respiratory samples.

Methods: Oligonucleotide primers for the amplification of the DNA of these three organisms were optimised for use in combination in the same reaction. PCR products were detected by hybridisation with pooled internal probes using an enzyme linked immunosorbent assay.

Clinical and serological associations with anti-RNA polymerase antibodies in systemic sclerosis.

There are three classes of RNA polymerase enzyme (RNAPs I, II and III). In systemic sclerosis (SSc), three main groups of anti-RNAP sera have been characterized by radioimmunoprecipitation techniques: anti-RNAP I/III sera, anti-RNAP I/II/III sera, and a group precipitating both RNAP II and topoisomerase I (topo I). Some sera in this third group precipitate the phosphorylated (IIO) form of RNAP II in the absence of the unphosphorylated (IIA) form.

Obturator neuropathy. An anatomic perspective.

Entrapment of the anterior division of the obturator nerve is a recently described cause of medial groin pain. This anatomic study examines the extrapelvic course of the nerve and related fascia in the adductor region to provide an anatomic basis for the syndrome and to aid in surgical treatment. Twelve anatomic specimen limbs were dissected to document the extrapelvic course of the obturator nerve, the myofascial arrangement, and the vasculature.

Magnetic resonance imaging differences between dementia with Lewy bodies and Alzheimer's disease: a pilot study.

Background: Temporal lobe atrophy on magnetic resonance imaging (MRI) has been suggested as a specific diagnostic marker for Alzheimer's disease (AD). No previous comparison with dementia with Lewy bodies (DLB) has been reported.

Method: T1-weighted MRI scans were performed on 11 subjects with AD (nine with NINCDS/ADRDA probable AD and two with neuropathologically proven AD) and nine subjects with DLB (four with probable DLB diagnosed by clinical criteria and five with neuropathologically proven DLB).

School nurse web authoring.

Many school nurses are now surfing the World Wide Web for clinical and professional information. The Web is also a tool for providing professional services and delivering nursing care. Three applications for school nursing are featured: using the Web for professional publishing, a state association web page, and a school nurse office website.