Pregnancy‐Associated Stroke

Cerebrovascular accident, or stroke, is the fourth leading cause of death for all women and the eighth leading cause of pregnancy‐associated death. The physiologic changes of pregnancy increase the risk of cerebrovascular accident for women. With current incidence rates, a facility with 3300 births per year can anticipate caring for one woman with a pregnancy‐related stroke at least every 2 years. All maternity care providers must be able to assess women experiencing stroke‐like symptoms and initiate timely care to mitigate brain tissue damage, decrease long‐term morbidity, and prevent mortality. The 2 main types of stroke, ischemic and hemorrhagic, have similar presenting symptoms but very different pathophysiology and treatment. This article reviews assessment and initial treatment of pregnant and postpartum women experiencing stroke and provides guidance for subsequent maternity and primary care to assist front‐line perinatal care providers who may be the first to treat affected women or may resume primary care after diagnosis.     

Direct orthotopic transplantation of fresh surgical specimen preserves CD133+ tumor cells in clinically relevant mouse models of medulloblastoma and glioma

Recent identification of cancer stem cells in medulloblastoma (MB) and high-grade glioma has stimulated an urgent need for animal models that will not only replicate the biology of these tumors, but also preserve their cancer stem cell pool. We hypothesize that direct injection of fresh surgical specimen of MB and high-grade glioma tissues into anatomically equivalent locations in immune-deficient mouse brains will facilitate the formation of clinically accurate xenograft tumors by allowing brain tumor stem cells, together with their non-stem tumor and stromal cells, to grow in a microenvironment that is the closest to human brains. Eight of the 14 MBs (57.1%) and two of the three high-grade gliomas (66.7%) in this study developed transplantable (up to 12 passages) xenografts in mouse cerebellum and cerebrum, respectively. These xenografts are patient specific, replicating the histopathologic, immunophenotypic, invasive/metastatic, and major genetic (analyzed with 10K single nucleotide polymorphism array) abnormalities of the original tumors. The xenograft tumor cells have also been successfully cryopreserved for long-term preservation of tumorigenicity, ensuring a sustained supply of the animal models. More importantly, the CD133(+) tumor cells, ranging from 0.2%-10.4%, were preserved in all the xenograft models following repeated orthotopic subtransplantations in vivo. The isolated CD133(+) tumor cells formed neurospheres and displayed multi-lineage differentiation capabilities in vitro. In summary, our study demonstrates that direct orthotopic transplantation of fresh primary tumor cells is a powerful approach in developing novel clinical relevant animal models that can reliably preserve CD133(+) tumor cell pools even during serial in vivo subtransplantations. Disclosure of potential conflicts of interest is found at the end of this article.     

Perspective: Implementation of Nursing Language in Long‐Term Care and Nursing Education

PURPOSE. This article describes one nurse's experiences of returning to school after a 10‐year absence, her introduction to nursing theory and terminology, and her subsequent implementation of nursing language in a long‐term care setting and later experiences in teaching nursing language to students. DATA SOURCES. A 21‐year career as a long‐term care nurse coincided with the evolution of the new organization North American Nursing Diagnosis Association International, and she found herself in a position to implement nursing diagnosis in the long‐term care setting. Practice experiences and pertinent nursing references and resources were used in clinical implementation and in teaching nursing students. DATA SYNTHESIS. The author reviewed the implementation and teaching of nursing language from a personal historical perspective. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE. The author's experiences and perspectives on implementation of nursing language in clinical practice and in teaching provide information and a perspective for nurses and students involved in these processes.     

"Leaving the Comfort of the Familiar": Fostering Workplace Cultural Awareness Through Short-Term Global Experiences

PROBLEM.  Facilitating the development of student nurses' cultural competence and translating these experiences into the clinical setting.
METHODS.  Qualitative methods.
FINDINGS.  A short-term global immersion experience informs student nurses' cultural awareness, education, and future clinical practice.
CONCLUSIONS.  Participation in a short-term global health experience contributes to students' personal growth and broadens their insight into multicultural care.     

Social Implications of Obstetric Fistula: An Integrative Review

Obstetric fistula is a devastating complication of obstructed labor that affects more than two million women in developing countries, with at least 75,000 new cases every year. Prolonged pressure of the infant's skull against the tissues of the birth canal leads to ischemia and tissue death. The woman is left with a hole between her vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal) or both, and has uncontrollable leakage of urine or feces or both. It is widely reported in scientific publications and the media that women with obstetric fistula suffer devastating social consequences, but these claims are rarely supported with evidence. Therefore, the true prevalence and nature of the social implications of obstetric fistula are unknown. An integrative review was undertaken to determine the current state of the science on social implications of obstetric fistula in sub‐Saharan Africa.