Search

Objective: To examine the influence of the nurse, the type of patient presentation and the level of hospital service on consistency of triage using the Australasian Triage Scale., Methods: A secondary analysis of survey data was conducted. The main study was undertaken to measure the reliability of 237 scenarios for inclusion in a national training programme. Nurses were recruited from a quota sample of Australian ED according to peer group. Analysis was performed to determine concordance: the percentage of responses in the modal triage category. Analysis of variance (anova) and Pearson correlations were used to investigate associations between the explanatory variables and concordance., Results: A total of 42/50 (84%) participants returned questionnaires, providing 9946 scenario responses for analysis. Significant differences in concordance were observed by variables describing the type of patient presentation and level of urgency. Mean scores for the comparison group (adult pain; 70.7%) were higher than the groups involving a mental health or pregnancy presentations (61.4%; P

Despite their important role in chemical, biological and radiological (CBR) incident response, little is known about emergency nurses' perceptions of these events. The study aim was to explore emergency nurses' perceptions of CBR incidents and factors that may influence their capacity to respond. Sixty-four nurses from a metropolitan Emergency Department took part. The majority were willing to participate in CBR incidents and there was a positive association between willingness to participate and postgraduate qualification in emergency nursing. Willingness decreased, however, with unknown chemical and biological agents. One third of participants reported limitations to using personal protective equipment. Few participants had experience with CBR incidents although 70.3 per cent of participants had undergone CBR training. There were significant differences in perceptions of choice to participate and adequacy of training between chemical, biological and radiological incidents. The study results suggest that emergency nurses are keen to meet the challenge of CBR incident response.

Aim: This paper is a report of a study to identify predictors of critical care admission in emergency department patients triaged as low to moderate urgency that may be apparent early in the emergency department episode of care. Background. Observations of clinical practice show that a number of emergency department patients triaged as low to moderate urgency require critical care admission, raising questions about the relationship between illness severity and physiological status early in the emergency department episode of care., Methods: A retrospective case control design was used. All participants were aged over 18 years, triaged to Australasian Triage Scale categories 3, 4 or 5, and attended emergency department between 1 July 2004 and 30 June 2005. Cases were admitted to intensive care unit or coronary care unit and controls were admitted to general medical or surgical units. Cases (n = 193) and controls (n = 193) were matched by age, gender, emergency department discharge diagnosis and triage category., Results: Critical care admission associated with: (i) a presenting complaint of nausea, vomiting and diarrhoea (OR = 3.40, 95%CI:1.22-9.47, P = 0.019), (ii) heart rate abnormalities at triage (OR = 2.10, 95%CI:1.19-3.71, P = 0.011), (iii) temperature abnormalities at triage (OR = 2.87 95%CI:1.05-7.89, P = 0.041), (iv) respiratory rate at first nursing assessment (OR = 1.66, 95%CI:1.05-2.06, P = 0.31) or (v) heart rate abnormalities at first nursing assessment (OR = 1.57, 95%CI = 1.04-2.39, P = 0.033)., Conclusion: Derangements in temperature, respiratory rate and heart appear to increase risk of critical care admission. Further work using a prospective approach is needed to establish which physiological parameters have the highest predictive validity, the level(s) of physiological abnormality with highest clinical utility, and the optimal timing for collection of physiological data.

Objective: To examine the effect of fast track on emergency department (ED) length of stay (LOS)., Design and Setting: Pair-matched case-control design in a public teaching hospital in metropolitan Melbourne, Australia., Participants: Patients treated by the ED fast track (cases) between 1 January and 31 March 2007 were compared with patients treated by the usual ED processes (controls) from 1 July to 15 November 2006 (n = 822 matched pairs)., Intervention: ED fast track was established in November 2006 and focused on the management of patients with non-urgent complaints., Main Outcome Measures: The primary outcome measure was ED LOS for fast-track patients. Secondary outcomes were waiting times and ED LOS for other ED patients., Results: Median ED LOS for non-admitted patients was 132 minutes (interquartile range (IQR) 83-205.25) for controls and 116 minutes (IQR 75.5-159.0) for cases (p<0.01). Fast-track patients had a significantly higher incidence of discharge within 2 h (53% vs 44%, p<0.01) and 4 h (92% vs 84%, p<0.01)., Conclusions: ED fast track decreased ED LOS for non-admitted patients without compromising waiting times and ED LOS for other ED patients.

Small molecule agonists and antagonists of the V(2)-vasopressin receptor have been discovered and have undergone clinical trials. In conjunction with these discovery programs, the synthesis and biological testing of various metabolites associated with these clinical targets were actively pursued. We now report the results of our synthetic efforts and the corresponding biological data generated for several of the metabolites of WAY-151932 and CL-347985 (Lixivaptan).

Aims: This study aimed to examine the effect of an educational intervention on discharge advice given to parents leaving the emergency department with a febrile child., Background: Childhood fever is a common reason to seek emergency care. Many children are discharged from the emergency department with fever as a significant component of their illness; therefore, it is vital that emergency department medical and nursing staff provide accurate and reliable information about childhood fever management., Design: A pre/post-test design was used. The outcome measure was parental advice regarding paediatric fever management and the intervention for the study was an educational intervention for emergency department nursing staff that consisted of two tutorials. Data were collected using structured telephone interviews., Results: Data were collected from 22 families during the pretest period and 18 families during the post-test period. The number of parents leaving the emergency department with no advice decreased by 48% (p = 0.002). Reports of written advice increased by 69.7% (p < 0.001) and there was a 38.4% increase in reports of verbal advice (p = 0.014). Parents leaving the emergency department with both written and verbal advice increased from 0 to 55.6% (p < 0.001). Reports of advice by nursing staff increased by 52% (p < 0.001) and there were significant increases in specific instructions related to oral fluid administration (22.7 vs. 77.8, p = 0.001) and use of antipyretic medications (27.2 vs. 77.8, p = 0.001)., Conclusion: Evidence-based education of emergency nurses improved both the amount and quality of discharge advice for parents of febrile children., Relevance to Clinical Practice: Parents and health care professionals alike need to better understand the physiological benefits of fever and the potential harmful effects of aggressive and often unwarranted treatment of fever.

Aim: This study examined the effect of an education intervention on emergency nurses' decisions related to oxygen administration., Method: A controlled pre-test/post-test quasi-experimental design was used. The intervention was a written self directed learning package. Outcome measures were (i) factual knowledge measured using parallel form multiple choice questions (MCQs) and (ii) clinical decisions measured using parallel form MCQs, parallel form patient scenarios and clinical practice observation., Results: Eighty-eight nurses from 4 Melbourne EDs participated in the study (control group: n=37 and experimental group: n=51). Subgroups of nurses from the experimental group also participated in the patient scenarios (n=20) and clinical practice observation (n=10). Emergency nurses' knowledge increased as a function of education. Both patient scenario data and clinical practice observation showed decreased selection of nasal cannulae, increased selection of air entrainment masks and a trend towards selection of higher oxygen flow rates following education., Conclusions: Evaluation of educational interventions in nursing should focus on identifying strategies that enhance learning in a clinical environment, are valid in terms of the clinical context and culture in which they are being used and most importantly, produce sustained improvements in actual clinical practice.

Accuracy of triage decisions is a major influence on patient outcomes. Triage nurses' knowledge and experience have been cited as influential factors in triage decision-making. The aim of this article is to examine the independent roles of factual knowledge and experience in triage decisions. All of the articles cited in this review were research papers that examined the relationship between triage decisions and knowledge and/or experience of triage nurses. Numerous studies have shown that factual knowledge is an important factor in improving triage decisions. Although a number of studies have examined the role of experience as an independent influence on triage decisions, none have found a significant relationship between experience and triage decision-making. Factual knowledge appears to be more important than years of emergency nursing or triage experience in triage decision accuracy. Many triage education programs are underpinned by the assumption that knowledge acquisition will result in improved triage decisions. A better understanding of the relationships between clinical decisions, knowledge, and experience is pivotal for the rigorous evaluation of education programs.

Introduction: This study examined the effect of an educational intervention of factual knowledge on emergency nurses' knowledge and clinical decisions related to paediatric fever., Method: A prospective pre-test/post-test design was used. Emergency nurses' factual knowledge was measured by parallel multiple choice questions and the intervention for the study was an educational intervention consisting of two tutorials. Pre-test data were collected in early June 2005 and post-test data were collected during August 2005., Results: Thirty-one emergency nurses completed the pre and post-test multiple choice questions. Emergency nurses' knowledge increased following the tutorials. Pre-test score was positively correlated with knowledge acquisition. Self-reports of independent decisions related to fever management were influenced by experience, hours of employment, level of appointment, postgraduate qualifications and pre-test score., Discussion: High levels of variability in knowledge and knowledge acquisition suggest a review of undergraduate and postgraduate curricula is warranted. Although this study identified associations between independent fever management decisions and participant characteristics, further research is pivotal to better understanding these relationships.

This study examined the emergency nurse practitioner candidate (ENPC) scope of practice in a Victorian emergency department (ED). The emergency nurse practitioner (ENP) role is relatively new in Victoria and the scope of the ENP(C) practice is yet to be defined. International research literature regarding the ENP role has focused on outcomes such as patient satisfaction, waiting times and/or ED length of stay, accuracy and adequacy of documentation, use of radiography, and patient education, health promotion and communication issues. A prospective exploratory design was used to conduct this cohort study. There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years. The majority (77.2%) of ENPC-managed patients were discharged from the ED. The majority of the ENPC time was devoted to clinical practice (55%) and development of clinical practice guidelines (25%). Of patients managed by the ENPC, 49.6% required medications, 51% required diagnostic imaging and 8.6% required pathology testing during their ED stay. The most common discharge referrals were made to local medical officers (73.5%) and the most common referrals made for patients requiring admission were made to the plastic surgery (37.3%) and orthopaedic (35.5%) units. Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP. The ENP model of care is an important strategy for the management of increased service demands in Victoria; however, little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined. Further research to better understand the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified.

Objective: The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care., Methods: A case-control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care., Results: There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS., Conclusion: Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.

The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses' clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses' decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre-test/post-test, quasi-experimental design was used. The intervention was a written, self-directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes.

Multiple choice questions are used extensively in nursing research and education and play a fundamental role in the design of research studies or educational programs. Despite their widespread use, there is a lack of evidence-based guidelines relating to design and use of multiple choice questions. Little is written about their format, structure, validity and reliability of in the context of nursing research and/or education and most of the current literature in this area is based on opinion or consensus. Systematic multiple choice question design and use of valid and reliable multiple choice questions are vital if the results of research or educational testing are to be considered valid. Content and face validity should be established by expert panel review and construct validity should be established using 'key check', item discrimination and item difficulty analyses. Reliability measures include internal consistency and equivalence. Internal consistency should be established by determination of internal consistency using reliability coefficients while equivalence should be established using alternate form correlation. This paper reviews literature related to the use of multiple choice questions, current design recommendations and processes to establish reliability and validity, and discusses implications for their use in nursing research and education.

Study Objective: The purpose of this study is to examine emergency nurses' performance using triage scenarios characterized by type of patient population (adult versus pediatric) and mode of delivery (paper versus computer)., Methods: A combination of paper-based (script alone) and computer-based (script plus still photographs) triage scenarios were used. Of the 28 scenarios used, half were written and half were computer based. Within each subgroup, there were 7 adult and 7 pediatric scenarios. Participants were asked to allocate an Australasian Triage Scale category for each triage scenario., Results: One hundred sixty-seven participants completed a total of 2,349 adult scenarios, and 161 participants completed 2,265 pediatric scenarios. Sixty-one percent of the triage decisions made by the nurses were "expected" triage decisions, 18% were "undertriage," decisions, and 21% were "overtriage" decisions. Nurse triage allocation decisions for the scenarios containing still photographs delivered by computer demonstrated a higher average agreement percentage of 66.2% (kappa=0.56; tau b =0.77; P <.0001) compared with the average agreement percentage of 55.4% (kappa=0.42; tau b =0.75; P <.0001) using paper-based (text-only) scenarios., Conclusion: The mode of delivery appeared to have an effect on the nurses' triage performance. It is unclear whether the use of simple still photographs used in the computer mode of delivery resulted in a higher incidence of expected triage decisions and, thus, improved performance. The use of cues such as photographs and video footage to enhance the fidelity of triage scenarios may be useful not only for the education of triage nurses but also the conduct of research into triage decisionmaking. However, further exploration and research in this area are warranted.

This article outlines the development, implementation and evaluation of the Career Development Year (CDY) in the Emergency Department (ED) at Dandenong Hospital in Victoria, Australia. As a consequence of a shortage of emergency nurses, hospitals have recruited inadequately prepared nurses to staff their EDs. The resultant increase in stress of qualified and experienced emergency nurses has had a major impact on the retention of emergency nurses. The CDY aims to provide nurses with little or no experience in emergency nursing with supported entry into this area of specialist practice. The CDY is based on three factors identified as important in the transition to emergency nursing; knowledge, clinical support and professional development. By providing beginning emergency nurses with supported entry to a new and challenging clinical environment, the CDY has been an effective recruitment and retention strategy. In addition it has demonstrated that a committed ED team has the capability to teach and nurture the emergency nurses of the future.

This case study involves a 36-year-old female at 15 weeks gestation who presented with severe lower abdominal pain post amniocentesis and subsequently deteriorated into a state of septic shock whilst in the ED. The circumstances surrounding this patient's presentation and subsequent clinical course are presented. The assessment and management of septic shock is also described with specific consideration to this patient's pregnant state.

Objective: To assess the cost effectiveness of a postal toothpaste programme to prevent caries in 5-year-old children in the north west of England., Participants: Birth cohorts of children aged 12 months were recruited from high caries risk populations in nine health districts., Design: The results of a randomised controlled trial to measure the effects of a postal toothpaste programme are used and related to the costs of running a similar programme. Children in the trial received free toothpaste on four occasions a year and a toothbrush once a year for four years from age 12 months to 5 years. When aged 5-6 years children were examined by trained, calibrated examiners using BASCD standards. Those who received toothpaste containing 1450 ppm F were found to have a significantly lower mean dmft than those who had not. The costs that would be incurred by a public dental service running such a postal toothpaste programme are identified, measured and related to the likely health improvement that could be achieved., Main Outcome Measures: The cost per tooth saved and the cost per child saved from caries experience and extraction experience., Results: The estimated cost per tooth saved from carious attack was pounds sterling 80.83 and the cost per child of preventing caries experience was pounds sterling 424.38 and avoiding any extractions was pounds sterling 679.01. Analysis resulted in an overestimation of costs and underestimation of benefits., Conclusion: The programme achieved a significant caries reduction in children who received the 1450 ppm F toothpaste and the costs are now available to those considering provision of treatment services in areas where children are at high caries risk.

Triage is the formal nursing assessment of all patients who present to an Emergency Department (ED). The National Triage Scale (NTS) is used in most Australian EDs. Triage decision making involves the allocation of every patients presenting to an ED to one of the five NTS categories. The NTS directly relates a triage category to illness or injury severity and need for emergency care. Triage nurses' decisions not only have the potential to impact on the health outcomes of ED patients, they are also used, in part, to evaluate ED performance and allocate components of ED funding. This study was a correlational study that used survey methods. Triage decisions were classified as 'expected triage', 'overtriage' or 'undertriage' decisions. Participant's qualifications were allocated to five categories: 'nil'; 'emergency nursing'; 'critical care nursing'; 'midwifery'; and 'tertiary' qualifications. There was no correlation between triage decisions and length of experience in emergency nursing or triage. 'Expected triage' decisions were more common when the predicted triage category was Category 3 (P < 0.001) and 'overtriage' decisions were less common when the predicted triage category was Category 2 (P < 0.0010). The frequency of 'undertriage' decisions decreased significantly when the predicted triage category was Category 3 (P < 0.001) or Category 4 (P < 0.001). There was no correlation between triage decisions and qualifications in the 'nil', 'emergency nursing' or 'critical care nursing' categories. A midwifery qualification demonstrated a positive correlation with 'expected triage' decisions (P = 0.048) and a negative correlation with 'undertriage' decisions (P = 0.012). There was also a positive correlation between a tertiary qualification and 'expected triage' decisions (P = 0.012).

The initiation of emergency care primarily depends on the decisions made by the triage nurse. Triage decisions can therefore have a profound effect on the health outcomes of patients who present for emergency care. If the National Triage Scale (NTS) was effective in providing a standardized approach to triage, a patient with a specific problem should be allocated to the same triage category, irrespective of the institution to which they present or the personnel performing the role of triage. This study examines triage nurses' level of agreement in their allocation of triage categories to patients with specific presenting problems using the NTS. Relationships between demographic characteristics of participants and triage decisions are examined and implications of any variation for triage practice and patient outcomes are explored.

The Clinical Nurse Educator (CNE) project saw the appointment and evaluation of a CNE position in the Emergency Department at Dandenong Hospital, Australia. The study aimed to identify the educational needs of nursing staff, the self reported levels of knowledge of nursing staff, the perceptions of nursing staff surrounding education and clinical support and to compare responses over the 6 month period to identify any statistically significant changes. Data was collected at three intervals during the study period and the responses compared using the Kruskal-Wallis test(H). Since the appointment of the CNEs, the reported levels of knowledge increased for all areas of emergency nursing included in the study. Tutorials, in-service education sessions, direct clinical support and self-directed learning packages were reported to be useful educational methods. There were increases in the reported adequacy of in-service education (P = 0.0000), level of clinical support and satisfaction with current level of knowledge in emergency nursing. Nursing staff found the process of basic and advanced life support assessment less intimidating (P = 0.0031), more important and less affected by workload constraints of the ED (P = 0.0002). The reported thoroughness of orientation of new employees (P = 0.0005) and levels of clinical support and education when orientated to the triage role (P = 0.0225) also increased., (Copyright 2000 Harcourt Publishers Ltd.)

Daycase cystoscopy under local anaesthetic is commonly used in screening patients with superficial transitional cell carcinoma of the bladder. Treatment of any lesions found, however, often requires a further cystoscopy under general or regional anaesthesia. Recent reports suggest that small lesions can be diathermied without anaesthesia with only mild patient discomfort. Suction diathermy electrodes, introduced for the treatment of small superficial bladder tumours, have significant advantages over conventional methods. Firstly, most of the superficial tumour fronds can be removed painlessly by suction alone. Diathermy, the uncomfortable component of treatment, is sparingly used to treat the tumour base. Larger tumours can therefore be treated by suction diathermy, with less patient discomfort, than by standard cystodiathermy methods. Secondly, by eliminating tumour debris within the bladder during treatment and reducing tissue damage due to diathermy, suction diathermy minimizes the risk of tumour recurrence due to implantation. In this preliminary report the ease and efficacy of using suction diathermy electrodes under local anaesthesia is assessed.

The concept of the consumer illness career with a focus on allergies is introduced and developed by the authors in terms of a trajectory of five stages over time, the related product-service unities or constellations--including health care treatments and remedies--and various situational and trait factors that influence the course of a consumer's response to his or her disease. Next, they investigate the career's holistic nature and thematic content in an in-depth study of allergy sufferers. The study indicates that allergy sufferers engage ina wide range of strategic behaviors and choices associated with coping with their allergies, much of which can be captured in terms of patterned themes. Finally, the authors offer research, managerial, and public policy implications.

The treatment of superficial bladder tumours (Ta, T1) is a time-consuming exercise for urological surgeons and patients. A method of treating the tumours, whether primary or recurrent, by endoscopic suction diathermy has been developed. The technique significantly reduces the amount of tumour debris within the bladder during treatment as well as the amount of diathermy employed. By removing the free tumour cells in the irrigation fluid the risk of tumour cell implantation may be kept to a minimum.

Cell division during development of the dermal system of fruit of the grape cv. Gordo is confined to the first growth period. The epidermis is conserved with anticlinal proliferative cell divisions providing for increase in cell number. The hypodermis is the layer of origin of the collenchymatous dermal system. Six or seven layers are differentiated by periclinal cell divisions early in the first growth period, and later increase in size is obtained by proliferative anticlinal cell divisions. These observations are related to developmental and genetic control of fruit shape and volume.

The skin around a lenticel on a soft fruit has been modelled as a thin elastic plate with a rigid circular inclusion and applied tensile loads at the edges. A solution for the stress distribution in the skin has then been found using the linear theory of elasticity. From that solution the severity of the stress concentration and the location and form of initial cuticular failure have been deduced, the latter two being in broad agreement with observed crack initiation in the cuticle of grapes.

The clinicopathologic features of 17 patients with xanthogranulomatous pyelonephritis are described, together with results on a number of histochemical and immunohistochemical techniques that were used to demonstrate the variety of cells involved. Based on our clinicopathologic data and review of the literature, we believe that xanthogranulomatous pyelonephritis should be regarded as a destructive, and, at times, tumefactive inflammatory process that may complicate chronic pyelonephritis. The initiation of this process remains an enigma. However, there appears to be three main features that are associated with xanthogranulomatous pyelonephritis: pelvicalyceal obstruction, ulceration of the pelvicalyceal urothelium, and bacterial infection.

The theory of shells has been applied to some aspects of the physics of fruit growth. Four form and structural attributes are identified which may intensify mechanical stress in the skin of a growing fruit and alter the distribution of that stress. One is a radius-related factor introduced by deviation of shape from that of a sphere and the other three are related to attachment of a fruit to a plant and to provision of a vascular system: core diameter, core tensile strength, and structure of the core/skin interface. The last factor also applies in principle to a hole which may be introduced for example at the style canal. These factors either alone or in combination can cause stresses far in excess of those predicted for a spherical shell of similar volume and wall thickness. They are considered in relation to their effect on fruit morphogenesis and the occurrence of disorders such as rainfall-induced splitting and cracking.

Endocrine manifestations are rarely observed in bladder urothelial neoplasia. To our knowledge, only 11 cases of choriocarcinoma have been reported in this site, and recently the production of beta-human chorionic gonadotropin has been demonstrated in these tumors by applying the immunoperoxidase technique. Of 104 transitional cell neoplasms of the bladder, we demonstrated by the indirect immunoperoxidase technique beta-human chorionic gonadotropin production in 12 neoplasms, 11 of which were grade 3 and 4 transitional cell carcinomas.

A histological study of surgical specimens of idiopathic hydronephrosis demonstrated an abnormal muscle arrangement at the ureteropelvic junction in 18 of 26 cases. We believe this abnormality to be the cause in these cases. At this junction, the muscle bundles, instead of displaying the normal interwoven (braided) pattern, are arranged into an outer circular and an inner longitudinal layer. This abnormal muscle arrangement can be attributed to local failure of the physiological uncoiling during growth and development.

Pure cultures of Physarum gyrosum were grown on agar plates with autoclaved Escherichia coli suspensions as the growth medium. Portions of such agar, after growth of the slime mold, contained diffusible materials that inhibited the growth of Bacillus subtilis, B. cereus, E. coli, Staphylococcus aureus, and Pseudomonas aeruginosa. Paper chromatography of extracts of such cultures revealed at least three different active fractions. Preliminary fractionations increased the specific activity by one order of magnitude, probably in part by removal of inactive material and in part by separating active components. The fractionations also demonstrated the multiplicity of the antibiotic activity. Fractions variously obtained always retarded the growth of the bacterial species listed above.