Reconceptualizing the core of nurse practitioner education and practice

Purpose: The movement to the doctor of nursing practice (DNP) is progressing rapidly with new programs emerging and curricular documents being developed. We argue that the implementation of the DNP is a good move for nursing, provided that we use the opportunity to reconceptualize the core of advanced practice nursing, especially nurse practitioner (NP) practice.
Data sources: Theory and research articles from nursing focused on advanced practice nursing, NPs, and doctoral education.
Conclusions: The foundation of NP education is currently based essentially on borrowed or shared content in assessment, pharmacology, and pathophysiology. We argue that the heart and soul of nursing is in health promotion, both in healthy persons and in those dealing with chronic illness. Current master's programs do not prepare NPs to assume high-level practice focused on health promotion and disease management using the latest theoretical developments in health behavior change, behavioral sciences, exercise physiology, nutrition, and medical anthropology. Although these are touched upon in most NP programs, they do not represent the core science of NP education and need to be a critical part of any DNP program.
Implications for practice: Ultimately, our vision is for NP care to be consistently "different," yet just as essential as physician care, leading to positive outcomes in health promotion and disease management.     

Comparison of Three Commonly Used Genetic Markers for Detection of Leishmania Major: An Experimental Study

BackgroundLeishmaniasis is a vector-borne disease caused by an intracellular protozoan parasite called Leishmania spp. Different species produce different clinical outcomes; the majority of cases are cutaneous forms. Leishmania major is one of the main causative agents of cutaneous leishmaniasis (CL). Various methods are being using to diagnose CL, including microscopic examination, culture, and molecular detection of the parasite genome.MethodIn the current study, we tried to compare three common molecular markers, including Kinetoplast DNA (kDNA), Cytochrome b (Cyt b), and Internal transcribed space 1 (ITS1), for the detection of Leishmania major. After cultivation of standard strain of L. major MHOM/IR/75/ER in RPMI 1640, certain number of promastigotes was subjected to DNA extraction and different PCR reactions.ResultsThe lowest number of the parasite (5 promastigotes) can be detected by kDNA-PCR, followed by Cyt b-PCR (10 promastigotes), and ITS1-PCR (50 promastigotes).ConclusionIn conclusion, kDNA-PCR was the most sensitive marker and may provide more reliable data in the initial screening, especially in false-negative results provided by parasitological methods due to the low number of parasites.     

The effect of pregnancy on renal clearance of boron in rats given boric acid orally.

Boric acid (H(3)BO(3)) has been shown to cause developmental abnormalities in the offspring of pregnant rats. Comparative data on the renal clearance of boron (B) in rats and humans, both pregnant and nonpregnant, exposed to boric acid (BA) would reduce uncertainty in interspecies extrapolation from rats to humans. The purpose of this study was to evaluate the effect of pregnancy on the plasma half-life and renal clearance of boron in Sprague-Dawley rats given a single oral dose of boric acid. For the half-life study, nonpregnant and pregnant (gestation day 16) rats were given a single dose of 30 mg/kg of boric acid by gavage, and plasma samples were collected at 2-3 h intervals. The plasma half-life of boron was determined to be 2.9 +/- 0.2 and 3.2 +/- 0.3 h in nonpregnant and pregnant rats, respectively. In the clearance study, nonpregnant and pregnant (GD 16) rats were given a single gavage dose of 0.3, 3, or 30 mg/kg of boric acid. Boron clearance was slightly higher in pregnant rats (3.3 +/- 0.6, 3.2 +/- 0.5, and 3.4 +/- 0.5 ml/min/kg, respectively) compared to nonpregnant rats (3.1 +/- 0.8, 3.0 +/- 0.6, and 3.2 +/- 0.5 ml/min/kg, respectively), but the difference was not statistically significant and not dose-related. Boron clearance was less than creatinine clearance, suggesting tubular reabsorption in both groups. In conclusion, pregnancy did not appear to significantly alter the renal clearance or the plasma half-life of boron in Sprague-Dawley rats under the conditions of this study.     

Sessile serrated adenomas in the proximal colon are likely to be flat,large and occur in smokers

AIM:To examine the epidemiology and the morphology of the proximal sessile serrated adenomas(SSAs).METHODS:We conducted a retrospective study to identify patients with SSAs using a university-based hospital pathology database query from January 2007to April 2011.Data collected included:age,gender,ethnicity,body mass index,diabetes,smoking,family history of colorectal cancer,aspirin,and statin use.We collected data on morphology of SSAs including site(proximal or distal),size,and endoscopic appearance(flat or protuberant).We also compared proximal SSAs to proximal tubular adenomas detected during same time period.RESULTS:One hundred and twenty patients with SSAs were identified:61%were distal and 39%were proximal SSAs.Proximal SSAs were more likely to be flat than distal(100%vs 78%respectively;P=0.0001).Proximal SSAs were more likely to occur in smokers(OR=2.63;95%CI:1.17-5.90;P=0.02)and in patients with family history of colorectal cancer(OR=4.72;95%CI:1.43-15.55;P=0.01)compared to distal.Proximal SSAs were statistically more likely to be≥6 mm in size(OR=2.94;P=0.008),and also more likely to be large(≥1 cm)(OR=4.55;P=0.0005)compared to the distal lesions.Smokers were more likely to have proximal(P=0.02),flat(P=0.01)and large(P=0.007)SSAs compared to non-smokers.Compared to proximal tubular adenomas,proximal SSAs were more likely to be large and occur in smokers.CONCLUSION:Proximal SSAs which accounted for two-fifths of all SSAs were more likely to present as flat lesions,larger SSAs,and were more likely to occur in smokers and in patients with family history of colorectal cancer.Our data has implications for colorectal cancer screening.     

The effect of modified transurethral sphincterotomy on autonomic dysreflexia

Autonomic dysreflexia continues to be a major problem in spinal cord injury patients. In our report 16 patients with spinal cord lesions above the T6 level and a history of autonomic dysreflexia also had detrusor-sphincter dyssynergia. Of these patients 12 (75 per cent) had evidence of dysreflexia during cystometry. In addition, the dysreflexic response in blood pressure was shown to correlate with the high intravesical and urethral pressures measured during cystometry. Modified transurethral sphincterotomies subsequently were performed on all patients as recommended therapy for detrusor-sphincter dyssynergia. Repeat cystometry revealed significant decreases in intravesical and urethral pressures compared to before sphincterotomy (p less than 0.001) along with an associated significant decrease in blood pressure (p less than 0.01). Other dysreflexic responses also were markedly attenuated. These results suggest an association among detrusor-sphincter dyssynergia, high intravesical and urethral pressures, and autonomic dysreflexia. Our data indicate further that the frequency and magnitude of autonomic dysreflexia can be diminished significantly by modified external sphincterotomy.     

Maintenance Hemodialysis in End-Stage Renal Disease Associated with Spinal Cord Injury

Data on maintenance hemodialysis in end-stage renal disease (ESRD) associated with spinal cord injury (SCI) are lacking. Forty-three SCI-ESRD patients treated with hemodialysis in our unit were retrospectively studied. A control group of ESRD patients without SCI were included for comparison. Predialysis concentrations of Na, K, bicarbonate, creatinine, albumin, calcium, and phosphorus and anion gap were significantly lower in the SCI group than in the control group. In contrast, chloride concentration was significantly higher in the SCI patients. Hemodialysis was equally effective in providing azotemia control and acid-base, electrolyte, and fluid balance in both groups. Interdialytic weight gain in the SCI group was significantly less than that of the control group. Hypotensive episodes during dialysis were quite common in the SCI patients. Interestingly, hypertensive episodes during or shortly after dialysis were also noted with considerable frequency. The hypotensive episodes usually responded to blood flow reduction and/or fluid administration. Hypertensive episodes were usually mild to moderate and reversed with continued dialysis without requiring vigorous intervention. The leg cramps often seen in ambulatory patients due to rapid ultrafiltration and fluid shifts were uncommon among the SCI patients. However, diffuse painful muscle spasms caused by uninhibited spinal reflexes were observed with considerable frequency and presented a difficult therapeutic problem. Due to prolonged immobilization and other factors, SCI-ESRD patients appear to be at high risk of thromboembolic disorders. SCI-ESRD patients thus appear to differ from the ambulatory ESRD patients from both clinical and biochemical viewpoints. These specific feaures can be of significant value with respect to the dietary and therapeutic considerations.     

Hematologic Features of Chronic Renal Failure Associated with Spinal Cord Injury

We examined the available hematologic data on 43 spinal cord injury (SCI) patients with end-stage renal disease (ESRD) treated with hemodialysis since 1972. A control group consisting of 45 ESRD patients without SCI was included for comparison. Moderate to severe anemia was found in all patients. The observed anemia was generally normocytic, normochromic, and associated with a low reticulocyte response. Transfusion requirement in the SCI group was considerably more than in the control group. There was a high incidence of splenomegaly, splenic amyloidosis, and lymph node enlargement in the SCI group. Lymph node and bone marrow amyloid deposits were found in some SCI patients but not in the control subjects.