The Department of Veterans Affairs pre- and post-doctoral nurse fellowships: diverse opportunities for research

The purpose of this article is to explicate research funding and training opportunities available through the Department of Veterans Affairs to nurses seeking advanced preparation at the pre- and post-doctoral levels. A brief discussion of the available resources including student stipend and health insurance, workspace, and research support is presented. Additionally, articulation of the benefits and challenges associated with these types of fellowships is delineated from the perspective of a fellow, Department of Veterans Affairs (VA) site preceptor, and dissertation faculty. Discussion of the post-doctoral fellowship and the extensive resources of the VA related to overall research career development are also addressed.     

Developing a team mentoring model

This article describes the authors' work in setting up a team mentoring system for nursing students on practice placements. The benefits include the ability to share responsibility for mentoring among clinicians and the exposure of students to a greater diversity of practice and teaching styles. Good communication is identified as crucial to effective implementation, while poor communication can be a potential barrier to the success of team mentoring.     

Discovery and characterization of QPT-1, the progenitor of a new class of bacterial topoisomerase inhibitors

QPT-1 was discovered in a compound library by high-throughput screening and triage for substances with whole-cell antibacterial activity. This totally synthetic compound is an unusual barbituric acid derivative whose activity resides in the (-)-enantiomer. QPT-1 had activity against a broad spectrum of pathogenic, antibiotic-resistant bacteria, was nontoxic to eukaryotic cells, and showed oral efficacy in a murine infection model, all before any medicinal chemistry optimization. Biochemical and genetic characterization showed that the QPT-1 targets the beta subunit of bacterial type II topoisomerases via a mechanism of inhibition distinct from the mechanisms of fluoroquinolones and novobiocin. Given these attributes, this compound represents a promising new class of antibacterial agents. The success of this reverse genomics effort demonstrates the utility of exploring strategies that are alternatives to target-based screens in antibacterial drug discovery.     

Cardiac biomarkers in patients with permanent pacemakers and implantable cardioverter-defibrillators undergoing an MRI scan

Background: Recent series suggest that magnetic resonance imaging (MRI) scanning can be performed safely in select patients with pacemakers or implantable cardioverter‐defibrillators (ICDs). Limited data have been reported on cardiac biomarker release following MRI scans in patients with pacemakers. The current study evaluated cardiac biomarkers pre‐ and postscan in patients with permanent pacemakers or ICDs undergoing MRI scanning of any body region without peak specific absorption rate (SAR) limit. Methods: Thirty‐seven patients with a total of 75 leads underwent a total of 40 MRI scans of both truncal and nontruncal regions using usual protocols with standard peak SAR settings for the scan. No patient was pacemaker dependent. Pacemaker magnet mode and ICD therapy were disabled during the scan. Baseline cardiac troponin‐I and myoglobin levels were obtained immediate pre‐ and 6–12 hours postscan. Pacemaker capture thresholds were measured immediately pre‐ and postscan. Results: The median peak SAR was 2.4 (1.3, 3.2) W/kg for all scans. Cardiac troponin‐I was unchanged following an MRI scan (0.01 (0.01, 0.02) versus 0.01 (0.01, 0.02) ng/mL, P = 0.90). Capture thresholds were no different pre‐ and postscan (0.67 (0.50, 0.80) versus 0.70 (0.50, 0.79) V at 0.5 ms, P = 0.50). Conclusions: The current series suggests that an MRI scan may be performed safely in carefully selected patients with close monitoring during the scan without limitation on peak SAR level or body landmark. Furthermore, it is unlikely that an MRI scan will produce sufficient tissue heating to cause enough myocardial cell necrosis to result in cardiac biomarker release.     

Training nursing students in evidence-based techniques for cognitive-behavioral pediatric pain management

This study evaluates the effects of a didactic training program for nursing students involving developmentally appropriate strategies for cognitive-behavioral pain management in children. Junior-level nursing students were assigned to one of two groups: training or control. Pretraining and posttraining knowledge and attitudes toward pain management were assessed. Implementation of cognitive-behavioral strategies was assessed via clinical role-play. Training participants had significantly more knowledge of cognitive-behavioral strategies after the training program versus before it, and they had more knowledge after the training program than did control participants. The training had no effect on attitude. In the role-play, training participants used a higher ratio of cognitive-behavioral strategies and implemented them in a higher quality manner than did control participants. These results suggest that a brief training program in cognitive-behavioral pain management can improve nursing students' knowledge of cognitive-behavioral pain management strategies and ability to implement them.     

Paliperidone extended-release tablets for the acute and maintenance treatment of schizophrenia

Background: Paliperidone, which is available in extended-release (ER) tablets, was approved by the US Food and Drug Administration in 2007 for the acute and maintenance treatment of schizophrenia. It is the seventh second-generation antipsychotic (SGA) to be introduced to the US market. Paliperidone is the major active metabolite of risperidone, an established anti-psychotic agent. Objective: This article reviews the available literature on the pharmacodynamics, pharmacokinetics, clinical efficacy, and tolerability of paliperidone. Methods: A comprehensive search of MEDLINE using the terms paliperidone, 9-hydroxy-risperidone, and Invega was performed for the years 1950 through December 2007. Articles that discussed the efficacy and tolerability of 9-hydroxy-risperidone formed as a metabolite of risperidone were excluded; all others were included. Abstracts and posters presented at recent national and international scientific meetings were also included in the review. Results: At therapeutic doses (3-12 mg), paliperidone ER follows linear pharmacokinetics. Like that of its parent drug, paliperidone's mechanism of action is thought to be through antagonistic actions at dopamine D(2) and serotonin-2A receptors. In vivo studies suggest that the cytochrome P450 enzyme system plays a minimal role in paliperidone metabolism, with none of the metabolites accounting for >10% of a dose. The majority (59%) of paliperidone is eliminated through the kidneys as unchanged drug. The results of three 6-week, randomized, double-blind, parallel-group trials indicated the efficacy of paliperidone ER compared with placebo in the treatment of acute exacerbations of schizophrenia, with response rates ranging from 39.8% to 61.0% for paliperidone ER, compared with 18.3% to 34.0% for placebo. During a 52-week, double-blind, relapse-prevention trial, the time to 25% of patients experiencing a recurrence was 83 days for paliperidone ER, compared with 23 days for placebo. The proportions of patients in the 6-week trials who reported at least 1 extrapyramidal symptom-related adverse event were 13%, 10%, 25%, 26%, and 24% for paliperidone ER 3, 6, 9, 12, and 15 mg/d, respectively; the pooled incidence rate was not statistically different from that with placebo (11%). Headache and insomnia were the most common adverse events in patients treated with paliperidone ER in the 6-week trials (pooled data: 11%-18% and 4%-14%, respectively). In the relapse-prevention trial, the incidence of prolactin-related adverse events was 4% for paliperidone ER and 0% for placebo. Conclusions: Current evidence supports the efficacy and tolerability of paliperidone ER in the acute and long-term treatment of schizophrenia. Randomized, head-to-head comparisons with other SGAs, particularly risperidone, are needed to define the role of paliperidone ER in the treatment of schizophrenia.     

Dietary behaviors predict glycemic control in youth with type 1 diabetes

OBJECTIVE—To investigate the association between dietary adherence and glycemic control among youth with type 1 diabetes.RESEARCH DESIGN AND METHODS—We conducted a cross-sectional analysis of 119 youth aged 9–14 years (mean ± SD 12.1 ± 1.6 years) with diabetes duration ≥1 year (5.4 ± 3.1 years). Dietary adherence was assessed using the Diabetes Self-Management Profile diet domain. Higher score defined greater dietary adherence. Glycemic control was determined by A1C.RESULTS—Dietary adherence score was inversely correlated with A1C (r = −0.36, P < 0.0001). In a multivariate model (R² = 0.34, P < 0.0001), dietary adherence (P = 0.004), pump use (P = 0.03), and caregiver education (P = 0.01) were associated with A1C. A1C of youth in the lowest (9.0%) tertile of diet score was higher than A1C of youth in the middle (8.1%, P = 0.004) and upper (8.4%, P = 0.06) tertiles. Dietary adherence uniquely explained 8% of the variance in A1C in the model.CONCLUSIONS—Greater dietary adherence was associated with lower A1C among youth with type 1 diabetes.Data for youth with type 1 diabetes demonstrate a gap between attained glycemic control and age-specific goals (1–3). With intensive insulin therapy, dietary behaviors become central to optimizing glycemic control. Studies have shown that greater dietary adherence improves glycemic control among adults with type 1 diabetes (4,5). In this study, we investigated the relationship between dietary adherence and glycemic control in youth with type 1 diabetes.