Advancing knowledge and research: developing a doctoral program in clinical and translational science

In an emerging field, such as clinical and translational science, questions of purpose and educational philosophy are crucial to consider as programs, competencies, and milestones are developed and become generally accepted as broad national standards. This article outlines issues to be taken into account as curricula are planned, implemented, and evaluated. It also discusses how philosophy, competencies, and assessments, including milestones, must be intertwined purposefully, with careful attention paid to the integration of knowledge, skills, and attitudes.     

Enhancing women's mood and energy: a research-based program for subthreshold depression using light, exercise, and vitamins

The prevalence and clinical significance of subthreshold forms of depression with sequelae comparable to major depression have been recently described in the literature; however, research on effective treatment is rare. A new intervention program that combines a specific regimen of light, exercise, and vitamins is effective in improving women's mood and overall sense of well-being. This program is well suited to many patients who present with somatic and psychological symptoms consistent with subthreshold depression.     

Patient and nurse safety: how information technology makes a difference

The Institute of Medicine's landmark report asserted medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology can shore up weak systems. For nursing, information technology plays a key role in protecting patients by eliminating nursing mistakes and protecting nurses by reducing their negative exposure. However, managing information technology is a function of managing the people who use it. This article examines critical issues that impact patient and nurse safety, both physical and professional. It discusses the importance of eliminating the culture of blame, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.     

Making a case: creating a perinatal palliative care service using a perinatal bereavement program model

This article explores the innovative approach of creating a perinatal palliative care service in an institution that already has a perinatal bereavement program. The proposed model focuses on the importance of establishing and maintaining relationship among and between nurses, other clinicians, and parents. The authors examine theoretical and clinical perspectives, recognizing the presence of both grief and hope from the moment of a life-threatening fetal diagnosis. The article identifies key program development processes, potential barriers, and practical implementation strategies as methods to ensure the delivery of seamless perinatal palliative care from diagnosis, through pregnancy, delivery, and the baby's living and dying.     

Evidence-based practice: a falls prevention program that continues to work

The successful implementation of an evidence-based falls prevention protocol in an acute care facility is described. The number of falls per 1000 patient days decreased by 50% without rebound over a 5-year period.     

Bridging the healthcare divide with patient navigation: development of a research program to address disparities

Americans who live in poverty as well as certain ethnic and racial groups have higher cancer death rates than other populations. Patient navigators have been identified as an important weapon against these disparities. Navigators can address insurance, financial, and logistical issues (e.g., transportation, appointment scheduling, child or elder care). They can provide understandable health education that may lessen fears of cancer diagnosis and treatment. This article describes the development and implementation of a multisite patient navigator program involving five cancer institutions in Western Pennsylvania. Navigator programs have great potential to enhance cancer care by reaching underserved populations and opening the door for future research.     

Squamous cell carcinoma of the oropharynx and oral cavity: How imaging makes a difference

The development of modern imaging techniques has significantly altered the treatment and management of these malignancies. Important treatment decisions that were once made intraoperatively are now made by using information from CT and MR imaging. The intent of this article is to provide the specific information that needs to be transmitted to the referring otolaryngologist or radiation oncologist and which will alter the treatment of patients with squamous cell carcinomas of the oral cavity and oropharynx.     

Factor VIII inhibitors: von Willebrand factor makes a difference in vitro and in vivo

Summary. Background: The important association between von Willebrand factor (VWF) and factor VIII (FVIII) has been investigated for decades, but the effect of VWF on the reactivity of FVIII inhibitory antibodies, referred to as inhibitors, is still controversial. Objective: To investigate the interaction among VWF, FVIII and FVIII inhibitory antibodies. Methods: Three sources of inhibitors were used for in vitro studies, including the plasma from immunized VWF^nullFVIII^null mice, purified plasma IgG from human inhibitor patients, or human monoclonal antibody from inhibitor patients’ B‐cell clones. Inhibitors were incubated with recombinant human FVIII (rhFVIII) either with or without VWF. The remaining FVIII activity was determined by chromogenic assay and inhibitor titers were determined. For in vivo studies, inhibitors and rhFVIII were infused into FVIII^null or VWF^nullFVIII^null mice followed by a tail clip survival test. Results: VWF has a dose‐dependent protective effect on FVIII, limiting inhibitor inactivation of FVIII in both mouse and human samples. A preformed complex of VWF with FVIII provides more effective protection from inhibitors than competitive binding of antibodies and VWF to FVIII. The protective effect of VWF against FVIII inactivation by inhibitors was further confirmed in vivo by infusing inhibitors and FVIII into FVIII^null or VWF^nullFVIII^null mice followed by a tail clip survival test. Conclusion: Our results demonstrate that VWF exerts a protective effect, reducing inhibitor inactivation of FVIII, both in vitro and in vivo.     

Partnership in action: a satellite program to expand an existing bachelor of science in nursing education program

The nursing shortage affects communities at many levels, from community hospitals to schools of nursing. The authors describe an innovative 4-way partnership involving a community healthcare district, a community hospital, a community college, and a state university. Working together, these partners established a new baccalaureate nursing program based at a community college and also functioning as a satellite of an existing university-based program, which increased the enrollment of baccalaureate nursing students by 50%. Their work could serve as a model for other collaborative efforts to expand nursing education and reduce the shortage of nurses.     

Center for the creation and dissemination of a new Japanese nursing science incorporating culturally appropriate care: Establishment and development of nursing science and arts based on clinical knowledge

This program aims to describe nursing care appropriate to the Japanese culture and to internationally disseminate the importance of culturally based care. Research will be conducted in a graduate school of nursing in collaboration with other graduate schools at Chiba University, such as those for social science and medical science.     

Size makes a difference: use of a low-prime cardiopulmonary bypass circuit and autologous priming in small adults

Low hematocrit (Hct < 20) during cardiopulmonary bypass (CPB) is associated with higher mortality and other adverse outcomes. More frequently, low Hct is encountered in patients with small body size and women patients. This prompted us to take an aggressive approach in our care of these patients, involving a strategy for predicting patients at risk of low Hct, with the aid of an electronic worksheet that accurately predicts CPB Hct, and two prevention strategies: use of a low-prime CPB circuit (LP) for all adult patients with a body surface area (BSA) < 1.7 m(2) and use of autologous circuit priming (AP), in addition to the low-circuit volume in some patients. The two cohorts of patients in whom these techniques were employed were compared to a group matched for body size where our standard adult circuit (STD) was used. There were 233 patients in the standard group, 139 in the LP group, and 68 in the LP/AP group. The CPB circuit prime volume was 1,710 ml for the STD group and 1,110 ml for the LP group. Use of autologous priming techniques further reduced the prime volume by 545 +/- 139 ml. The incidence of low Hct (<20%) during CPB was thus reduced from 70% to 15% (p = 0.001) when using both techniques together without increasing red blood cell (RBC) transfusions. These changes in perfusion management resulted in a reduction in the incidence of renal complications (STD = 9.4%, LP = 6.5% (ns) and LP/AP = 0%,     

Falls in older adult psychiatric patients: equipping nurses with knowledge to make a difference

Falls are the most common cause of accidental death among older adults and are associated with increased morbidity and mortality. A particularly serious sequela of falls is osteoporotic fractures. Older adults with mental illness are at increased risk of both falls and subsequent fractures, because of a range of complex risk factors. Many falls are preventable and an awareness of the risk factors for falls among nurses will empower them to promptly refer a patient at risk to the multidisciplinary team. A multidisciplinary approach is required to be successful in any efforts to reduce an individual's risk of falls and nurses have a central role in achieving this. This article reviews the relevant literature on the causes and consequences of falls in older adults with mental illness in order to enable nurses to reduce falls and subsequent fractures.