This study involves a unique cohort of training and qualified nurse hysteroscopists educated with the same provider. The aim of the research study was to explore the experiences of nurse hysteroscopists undertaking 'see and treat' outpatient hysteroscopy services. There is plenty of literature of advanced practice and activities of an advanced practitioner but with limited contextualisation of socio-cultural implications of taking on a specialised clinical role and what it means for the nurse. The wider sociological issues of organisations, feminisation of the health service and gendered occupational boundaries were considered. The research takes a case study approach. In phase one, nine nurses participated in creating mind maps with storytelling narratives providing an in-depth understanding of their working lives. The maps illustrated organisational relationships with each nurse who then developed the story behind the map which was digitally recorded. The interviews lasted an average 45 minutes. Each of the nurses had their map and summaries of the analysis returned to them for comment. The second phase of the study used an on-line survey based on issues raised in phase one. This enabled more of the study group to participate and established a degree of commonality between the two groups. Twenty-six nurses participated. A descriptive analysis of the data and qualitative comments are compared with those of the interviewees. Key findings are set into context of the health service in the 21st century. It is proposed that there is a culture of organisational closure. Frustration due to poor organisational culture requires nurses to use significant effort in negotiation with and for services in order to achieve their full potential. Inconsistent planning, no sustained sense of purpose from senior staff and professional jealousy required nurses to use skills associated with emotional intelligence to sustain themselves and maintain the hysteroscopy service. Recommendations include developing the nurses‟ interpersonal and social skills. A model is proposed for developing services and a recommendation made that a more strategic approach is taken by organisations.

The aims of this mixed methods research study were twofold: (1) To explore the impact(s) of a cardiac rehabilitation progrmme (CRP) on the quality of life (QOL) of older cardiac patients who experienced either a myocardial infarction (MI) and/or a coronary artery bypass graft (CABG) and/or a percutaneous coronary intervention (PCI), otherwise known as a coronary angioplasty; and (2), To construct a QOL conceptual model based on the quantitative and qualitative aspects of the patient‟s bio-psycho-social-spiritual aspects of QOL on a CRP. The research sought to answer four research questions devised around the physiological, psychological, and sociological domains of QOL. A mixed methods design was used, under the rubric of a critical realist theoretical approach. The physical domains of QOL focused on the cardiac patients specific physiological measurements using a pre-test-post-test design in order to develop a deeper understanding, of the structures, mechanisms, contexts and outcomes of the CRP. Qualitative components focused on the subjective domains of QOL taken from the eclectic perspectives of cardiac health care professionals and cardiac patients using semi-structured interviews to develop an in-depth understanding of the bio-psycho-social-spiritual and health impacts of the programme. Thirty-five cardiac patients (n = 35) formed a non-random purposive sample for the quantitative component of the study. Using the same type of sampling method for the qualitative component, ten cardiac health care professionals (n = 10) and seven cardiac patients (n = 7) were interviewed to determine the various impact(s) that the programme had on the patients different domains of QOL. The results, derived from dual perspectives, indicated that the CRP had strong positive impacts on the patient‟s QOL across the bio-psycho-social-spiritual domains of QOL. The newly created QOL conceptual model, entitled „The Ripple Impact Model (TRIM)‟of QOL for Older Patients with Coronary Heart Disease (CHD)‟ reflects the dynamic nature of an older cardiac patient‟s QOL on a CRP in view of how they define the concept globally from both medical and non-medical perspectives.

Learning disability (LD) affects around 2.5% of the population in the United Kingdom. Yet, the phenomenon of caring for people with communication difficulties and a learning disability (PCDLD) experiencing distress within palliative care settings is not fully understood. This study aims to gain an in-depth phenomenological understanding of how Registered Learning Disability Nurses (RNLDs) and Palliative Care Professionals (PCPs) identify and respond to the distress of PCDLD in palliative care settings. The objectives are: (a) to critically explore the lived experiences of RNLDs and PCPs who care for PCDLD experiencing distress in palliative care settings; and (b) to critically explore factors which determine how PCDLD express distress in palliative care settings. Hermeneutic phenomenological methodology incorporating a constructivist perspective was followed. Purposive sampling was used to capture professional and demographic attributes from LD nursing homes, community LD teams, and hospices. Thirteen participants consisting of eight RNLDs and five PCPs were interviewed. Data was collected by semi-structured, audio-recorded interviews, field-notes, and demographic questionnaires. Data analysis was thematic following Van Manen. Ethical approval was gained from the university Research Ethics Panel and from individual research locations. The findings indicated that Knowing by building relationships; Positivity in successful caring outcomes; Humane care; Moral duty of care; Time to care; Comfortable care environment; and Future perspectives encapsulate the primary strategies used to identify and respond to the distress of PCDLD. An essence statement portrayed the understood meaning of the fundamental nature of participants’ experiences of caring for PCDLD. The essence statement also informed both the development of a ‘New Theoretical Model of Palliative and End-of-care for PCDLD within Palliative Care Settings’, and a prototype ‘Checklist to enable social and healthcare professionals to self-evaluate their personal professional practice and the holism of care provided to PCDLD in palliative care settings’.

No description available.

This thesis describes a project using a qualitative study approach. It explores the utilization of the pre-registration period as preparation for clinical nurse leadership relevant to work in contemporary health care. The empirical focus of this study was to fundamentally address only the perceptions of senior student nurses about to qualify, of their own leadership development during their programme. Using focus groups with a total of 35 third year pre-registration students about to qualify as nurses provided a rich and detailed description of what inhibited and enhanced the development of their leadership skills. Alongside this, the students' perceptions of qualities and competencies required specifically for contemporary nurse leader roles were identified. No substantive studies exist in the United Kingdom exploring the experiences and perceptions of student nurses regarding nurse leadership during their training. It is distinctive as it challenges the state of nurse leadership in healthcare and the expected developmental needs for it. Students recognised the need to be prepared for leadership during their pre-registration programme and questioned the use of the standard theoretical approach for its development. They asked instead for skills to deal with difficult conversations, unexpected power struggles, challenging and dealing with inappropriate behaviour and introducing evidence into practice in areas of resistance. The study makes an important contribution to education as the findings can inform leadership development throughout the pre-registration nursing programmes within England. It also raises the question as to whether nursing needs more leaders, or just for nurses to take the professional responsibility for their own practice.

Using Casebook Ethnography, nine registered Adult Nurses were observed and interviewed to explore the ways in which they undertook their daily work and the place of reflection in that. The participants were employed in one of two units; a surgical breast care and an acute palliative care unit, both of which were in a large National Health Service trust hospital in central England. Data collection was illuminated by the researcher’s reflective journal. The data collected, rather than simply describing reflective practice, led to wider and more broadly focussed findings which, when analysed, generated one central theme - Communication, Interaction and Discourse and three linked associate themes - Being and Caring, Practical Action, and Knowing. These themes were considered in the light of the key literature around nursing practice and reflection. The findings point to a new understanding of contemporary nursing practice, which illustrates ‘what our kind does’, amongst the groups of participants in order to deliver patient-focussed care. This practice was directed towards working with colleagues who shared the same values and understandings, and who used these shared beliefs to adapt their practice to achieve individualised and exquisite care. As they communicated and interacted with one another, the participants went about their work with attention to empathy and caring, articulated as a common humanity with their patients. They prioritised action where patient need was clear, and used a form of knowledge that was negotiated and validated within a community of practice. As they maintained a dialogue in their teams, the participants developed a sense of their professional identity and of who qualified as ‘our kind’. The implications of this study are that a fuller understanding of how nurses work in contemporary practice will inform the preparation and continuing professional development of nurses and the ways in which effective clinical leadership may be implemented.

Este estudo teve como objetivo detectar a presença do vírus da raiva em diferentes órgãos de morcegos do gênero Artibeus empregando as técnicas moleculares como RT-PCR, hnRT-PCR e Real Time RT-PCR. De aproximadamente 4000 espécimes de morcegos recebidas no Instituto Pasteur para o diagnóstico da raiva, foram selecionados 30 morcegos do gênero Artibeus, com resultados positivos para raiva pelas técnicas tradicionais de IFD e inoculação em células N2A utilizando suspensões feitas a partir do SNC. Para as técnicas moleculares, foram retirados glândulas salivares, bexigas urinárias, rins, pulmões e conteúdos fecais e ainda foram lavadas as calotas cranianas dos espécimes. Os órgãos e conteúdos fecais foram diluídos a 1:10 (P/V) e as bexigas urinárias a 1:20 (P/V). As suspensões foram inoculadas em células N2A para o isolamento viral. Foi realizada a extração do RNA total usando o TRIzol®, foram realizadas a transcrição reversa seguida da PCR e hnRT-PCR com utilização de primers específicos para o gene codificante da proteína N. A partir do produto da transcrição reversa foi realizada a técnica de Real Time RT-PCR, utilizando primers e sonda específicos para variante antigênica 3. Das 30 suspensões de lavado cerebral, 28 (93,33%) resultaram positivos, na inoculação em cultura de células, seguido de glândulas salivares (36,67%), bexigas (16,67%) e conteúdos fecais (3,33%). Os resultados encontrados da sensibilidade nas técnicas de RT-PCR, hnRT-PCR e Real Time RT-PCR foram 56,25%, 82,57% e 82,19% quando avaliadas as 180 amostras analisadas. A comparação das técnicas de hnRT-PCR e Real Time RT-PCR feita pelo teste exato de Fisher quanto a proporção de positivos detectados mostrou que para o lavado cerebral, órgãos e conteúdos fecais a proporção foi igual (P>0,05). Em relação à positividade os resultados encontrados nas técnicas de hnRT-PCR e Real Time RT-PCR foram 100% em lavado cerebral; 90% e 93,33% em glândulas salivares; 83,33% e 90% em bexigas; 80% e 93,33% em rins; 76,67% e 50% em pulmões e 43,33% em ambas as técnicas em conteúdos fecais. Esses resultados sugerem que tanto as técnicas de hnRT-PCR como Real Time RT-PCR podem ser utilizadas como métodos complementares para o diagnóstico da raiva e são sensíveis o bastante para o uso em estudos de patogênese. A técnica de Real Time RT-PCR realizada neste estudo se mostrou eficiente em detectar o RABV em diferentes órgãos e tecidos extraneurais com a vantagem de ser uma técnica mais rápida e sensível. / This study was aimed to detect the presence of rabies virus in different organs of the genus Artibeus bats using molecular techniques such as RT-PCR, hnRT-PCR, and the Real Time RT-PCR. From about 4,000 specimens of bats received for rabies diagnosis at the Pasteur Institute, 30 bats of the genus Artibeus were then selected. The selected bats presented positive results by the traditional DFA and N2A-cells inoculation test using brain tissue suspensions. Samples of salivary glands, urinary bladders, kidneys, lungs, and fecal contents and washings of the skulls were collected for the molecular techniques testing. The organs and the fecal contents were diluted at 1:10 (w/v) and the urinary bladder, at 1:20 (w/v) and these suspensions were inoculated into N2A cells for viral isolation. The extraction of the total RNA was performed by using TRIzol® and followed by the reverse transcription and the PCR and the hnRT-PCR were performed by using specific primers for the gene encoding the protein N. The product obtained by the reverse transcription technique was submitted to the Real Time RT-PCR technique, using primers and probe specific for antigenic variant 3 of the rabies virus. Of the 30 suspensions of the brain washings, 28 (93.33%) were positive in N2A cell culture inoculation, followed by the suspensions of the salivary glands (36.67%), bladders (16.67%) and fecal contents (3.33%). For the 180 samples evaluated, the results of sensitivity found for the RT-PCR, hnRT-PCR and Real Time RT-PCR techniques were 56.25%, 82.57%, and 82.19%, respectively. A comparison of hnRT-PCR and Real Time RT-PCR techniques performed by Fisher\'s exact test showed that the proportion of positives detected by the brain washings, organs and of the fecal content was non-significant (P> 0.05). Regarding the results found in hnRT-PCR and Real Time RT-PCR techniques, 100% positives were in brain washing, 90% and 93.33% in salivary glands, 83.33% and 90% in bladders, 80% and 93.33% in kidneys, 76.67% and 50% in lungs and 43.33% for both techniques on fecal contents. These results suggest that both hnRT-PCR and Real-Time PCR techniques can be used as complementary methods for the diagnosis of rabies and are sensitive enough for use in pathogenesis studies. The Real Time RT-PCR technique performed in this study proved to be faster and more sensitive and effective in detecting RABV in different organs and extra neural tissues of bats.

Este estudo teve como objetivo detectar a presença do vírus da raiva em diferentes órgãos de morcegos do gênero Artibeus empregando as técnicas moleculares como RT-PCR, hnRT-PCR e Real Time RT-PCR. De aproximadamente 4000 espécimes de morcegos recebidas no Instituto Pasteur para o diagnóstico da raiva, foram selecionados 30 morcegos do gênero Artibeus, com resultados positivos para raiva pelas técnicas tradicionais de IFD e inoculação em células N2A utilizando suspensões feitas a partir do SNC. Para as técnicas moleculares, foram retirados glândulas salivares, bexigas urinárias, rins, pulmões e conteúdos fecais e ainda foram lavadas as calotas cranianas dos espécimes. Os órgãos e conteúdos fecais foram diluídos a 1:10 (P/V) e as bexigas urinárias a 1:20 (P/V). As suspensões foram inoculadas em células N2A para o isolamento viral. Foi realizada a extração do RNA total usando o TRIzol®, foram realizadas a transcrição reversa seguida da PCR e hnRT-PCR com utilização de primers específicos para o gene codificante da proteína N. A partir do produto da transcrição reversa foi realizada a técnica de Real Time RT-PCR, utilizando primers e sonda específicos para variante antigênica 3. Das 30 suspensões de lavado cerebral, 28 (93,33%) resultaram positivos, na inoculação em cultura de células, seguido de glândulas salivares (36,67%), bexigas (16,67%) e conteúdos fecais (3,33%). Os resultados encontrados da sensibilidade nas técnicas de RT-PCR, hnRT-PCR e Real Time RT-PCR foram 56,25%, 82,57% e 82,19% quando avaliadas as 180 amostras analisadas. A comparação das técnicas de hnRT-PCR e Real Time RT-PCR feita pelo teste exato de Fisher quanto a proporção de positivos detectados mostrou que para o lavado cerebral, órgãos e conteúdos fecais a proporção foi igual (P>0,05). Em relação à positividade os resultados encontrados nas técnicas de hnRT-PCR e Real Time RT-PCR foram 100% em lavado cerebral; 90% e 93,33% em glândulas salivares; 83,33% e 90% em bexigas; 80% e 93,33% em rins; 76,67% e 50% em pulmões e 43,33% em ambas as técnicas em conteúdos fecais. Esses resultados sugerem que tanto as técnicas de hnRT-PCR como Real Time RT-PCR podem ser utilizadas como métodos complementares para o diagnóstico da raiva e são sensíveis o bastante para o uso em estudos de patogênese. A técnica de Real Time RT-PCR realizada neste estudo se mostrou eficiente em detectar o RABV em diferentes órgãos e tecidos extraneurais com a vantagem de ser uma técnica mais rápida e sensível. / This study was aimed to detect the presence of rabies virus in different organs of the genus Artibeus bats using molecular techniques such as RT-PCR, hnRT-PCR, and the Real Time RT-PCR. From about 4,000 specimens of bats received for rabies diagnosis at the Pasteur Institute, 30 bats of the genus Artibeus were then selected. The selected bats presented positive results by the traditional DFA and N2A-cells inoculation test using brain tissue suspensions. Samples of salivary glands, urinary bladders, kidneys, lungs, and fecal contents and washings of the skulls were collected for the molecular techniques testing. The organs and the fecal contents were diluted at 1:10 (w/v) and the urinary bladder, at 1:20 (w/v) and these suspensions were inoculated into N2A cells for viral isolation. The extraction of the total RNA was performed by using TRIzol® and followed by the reverse transcription and the PCR and the hnRT-PCR were performed by using specific primers for the gene encoding the protein N. The product obtained by the reverse transcription technique was submitted to the Real Time RT-PCR technique, using primers and probe specific for antigenic variant 3 of the rabies virus. Of the 30 suspensions of the brain washings, 28 (93.33%) were positive in N2A cell culture inoculation, followed by the suspensions of the salivary glands (36.67%), bladders (16.67%) and fecal contents (3.33%). For the 180 samples evaluated, the results of sensitivity found for the RT-PCR, hnRT-PCR and Real Time RT-PCR techniques were 56.25%, 82.57%, and 82.19%, respectively. A comparison of hnRT-PCR and Real Time RT-PCR techniques performed by Fisher\'s exact test showed that the proportion of positives detected by the brain washings, organs and of the fecal content was non-significant (P> 0.05). Regarding the results found in hnRT-PCR and Real Time RT-PCR techniques, 100% positives were in brain washing, 90% and 93.33% in salivary glands, 83.33% and 90% in bladders, 80% and 93.33% in kidneys, 76.67% and 50% in lungs and 43.33% for both techniques on fecal contents. These results suggest that both hnRT-PCR and Real-Time PCR techniques can be used as complementary methods for the diagnosis of rabies and are sensitive enough for use in pathogenesis studies. The Real Time RT-PCR technique performed in this study proved to be faster and more sensitive and effective in detecting RABV in different organs and extra neural tissues of bats.

Os Vesiculovirus são um gênero de vírus de RNA da família Rhabdoviridae que inclui os sorotipos Carajás, Cocal, Marabá, Piry, Alagoas e Indiana. Estes são causadores de estomatite vesicular em ruminantes e doença febril humana no Brasil. As vesiculoviroses e suas epidemiologias são pouco conhecidas em seres humanos. Ainda, os Vesiculovirus (VSV) são pouco diagnosticados no homem e em animais pela escassez de métodos laboratoriais diagnósticos. Por isso, objetivamos neste trabalho desenvolver e testar uma RT-PCR em tempo real, pelo método SYBR Green, visando à detecção de VSV brasileiros. Primers que amplificam parte do gene da proteína G dos VSV foram utilizados no teste o qual mostrou-se capaz de detectar genomas dos VSV Piry, Indiana, Alagoas e Carajás. O método foi usado para testar amostras séricas de pacientes com doença febril aguda, de bovinos, de equinos e de macerados de artrópodos. A RT-PCR em tempo real mostrou-se 100 vezes mais sensível que a RT-PCR convencional para Vesiculovirus e também, permitiu detectar até 10 cópias de RNA do vírus Piry. Ainda, a RT-PCR em tempo real para Vesiculovirus mostrou-se capaz de diagnosticar e quantificar o VSV Alagoas nas amostras séricas de bovinos e de equinos. Portanto, a RT-PCR em tempo real desenvolvida neste trabalho, provavelmente, será muito útil no diagnóstico e também, em futuras pesquisas, que permitirão ampliar o conhecimento epidemiológico, ainda pouco conhecido, sobre os Vesiculovirus. / The Vesiculovirus is a Rhabdoviridae family genre of RNA virus that includes serotypes Carajás, Cocal, Maraba, Piry, Alagoas and Indiana. These are causes of vesicular stomatitis in ruminants and human febrile illness in Brazil. The vesiculoviroses and its epidemiology are little known in humans. Still, Vesiculovirus (VSV) are poorly diagnosed in humans and laboratory animals by the lack of diagnostic methods. Therefore, we proposed in this work to develop and test a real-time RT-PCR by SYBR Green method, focusing on the detection of Brazilian VSV. Primers that amplify part of the VSV G protein gene were used in the test which proved capable of detecting genomes of VSV Piry, Indiana, Alagoas and Carajás. The method was used to test serum samples from patients with acute febrile disease, cattle, horses and macerated arthropods. Real time RT-PCR showed to be 100 times more sensitive than conventional RT-PCR for Vesiculovirus and also was possible to detect up to 10 RNA copies of the Piry virus. Also, the real-time RT-PCR for Vesiculovirus proved able to diagnose and quantify Alagoas VSV in serum samples from cattle and horses. Therefore, the real-time RT-PCR developed in this work will probably be very useful in the diagnosis and in future research, which will increase the epidemiological knowledge, as it is still little known about the Vesiculovirus.

Alicyclobacillus acidoterrestris são bactérias termoacidófilas esporofórmicas não patogênicas e estão comumente presentes em sucos de frutas ácidas, podendo deteriorá-los. Tendo em vista a importância da atividade agrícola e seus derivados no país, como suco de laranja industrializado, o interesse no desenvolvimento de técnicas bioanalíticas que propiciem uma detecção rápida, sensível e confiável, bem como alternativas para inativação desse microrganismo, é elevado. Neste trabalho foi testado o uso de saponina como agente inibidor de esporos e células vegetativas de A. acidoterrestris, em sucos de laranja concentrado e reconstituído. Entretanto, à temperatura ambiente a inibição é lenta, especialmente para esporos (cerca de 10 dias para inibição total), inviabilizando o seu uso na indústria de cítricos. A combinação de tratamento térmico e saponinas potencializaram a inibição da bactéria, o que torna possível sua aplicação industrial. A potencialização com temperatura alcançou 20% para esporos em suco concentrado, 28,5% para esporos em suco reconstituído e 45,1% para células vegetativas em sucos reconstituídos. A detecção da viabilidade celular foi realizada pela reação em cadeia da polimerase por transcrição reversa (RT-PCR), que se mostrou uma técnica rápida, sensível, e quantitativamente equivalente ao método padrão de detecção, o plaqueamento de culturas, sendo o coeficiente de correlação (r) entre as técnicas de 0,9977 para esporos e 0,9987 para células vegetativas. A quantificação dos produtos da RT-PCR foi realizada por eletroforese capilar em microchip com o equipamento Bioanalyzer 2100. O equipamento forneceu resultados confiáveis e reprodutíveis para diagnóstico de DNA transcrito de A. acidoterrestris. Além da alta sensibilidade, o equipamento permitiu um mínimo consumo de amostra (1 μL), praticidade e rapidez. / Alicyclobacillus acidoterrestris are termoacidophilic sporeforming nonpathogenic bacteria who are commonly present in acidic fruit juices and can deteriorate them. In view of the importance of agricultural activities in the country and its derivatives, such as industrialized orange juice the interest in the development of bioanalitycal techniques that provide early, sensitive, and reliable detection, as well as alternatives to inactivate the microorganism is elevated. This study tested the use of saponins as an inhibitor of spores and vegetative cells of A. acidoterrestris in both concentrate and reconstituted orange juices. At room temperature, however, the inhibition is slow, especially for spores (about 10 days for a total inhibition), preventing its use in the citrus industry. The combination of heat treatment and saponins potentiated the inhibition of bacteria, which makes possible their industrial application. Optimizing the temperature reached 20% for spores in juice concentrate, 28.5% for spores in reconstituted juice and 45.1% for vegetative cells in reconstituted juices. Detection of cell viability was performed by reverse transcription polymerase chain reaction (RT-PCR), which showed to be a fast, sensitive, and quantitative equivalent to the traditional plating technique, and the correlation coefficient (r) between the techniques were 0.9977 and 0.9987 for spores and vegetative cells, respectively. The quantification of the products of RT-PCR was performed by capillary electrophoresis on microchip with Bioanalyzer 2100 equipment. The equipment provided reliable and reproducible results for the diagnosis of DNA transcript of A. acidoterrestris. Besides of high sensitivity, the equipment allowed minimal consumption of sample (1 μL) and provided convenience and speed of analysis.