Nursing, healthcare, and culture: a view of the year 2050 from Germany and the United kingdom

This column presents a dialogue with German nurse scholar Gerd Bekel and United Kingdom nurse scholars, Francis C. Biley and Kirstin Fragemann, who share their respective visions and understanding of each country's vision of nursing, healthcare, and quality of life in the year 2050.     

Systematic review and meta-analysis of primary healthcare interventions on health actions in people with intellectual disability

Background People with intellectual disability have substantially more unidentified health needs than the general population. We systematically reviewed the effectiveness of primary healthcare interventions intended to increase health actions for people with intellectual disability.

Methods Electronic databases were searched on 16 September 2014. Randomised and non-randomised studies with a concurrent control group were identified. Study quality was assessed and, where possible, meta-analysis was undertaken.

Results Five studies (3 randomised controlled trials, 1 matched cohort study, and 1 cohort study) with a total of 1,570 participants were included. General practitioner-led health checks were the most effective intervention and resulted in significantly more clinical activities, such as vision testing (risk ratio [RR]?=?3.3, 95% CI [2.3, 4.7]) and hepatitis B vaccinations (RR?=?2.4, 95% CI [1.7, 3.4]).

Conclusions Health checks were the only intervention to significantly increase short-term health promotion and disease prevention activity. The long-term effect of any intervention remains unknown.     

Generation of GFAP::GFP astrocyte reporter lines from human adult fibroblast‐derived iPS cells using zinc‐finger nuclease technology

Astrocytes are instrumental to major brain functions, including metabolic support, extracellular ion regulation, the shaping of excitatory signaling events and maintenance of synaptic glutamate homeostasis. Astrocyte dysfunction contributes to numerous developmental, psychiatric and neurodegenerative disorders. The generation of adult human fibroblast‐derived induced pluripotent stem cells (iPSCs) has provided novel opportunities to study mechanisms of astrocyte dysfunction in human‐derived cells. To overcome the difficulties of cell type heterogeneity during the differentiation process from iPSCs to astroglial cells (iPS astrocytes), we generated homogenous populations of iPS astrocytes using zinc‐finger nuclease (ZFN) technology. Enhanced green fluorescent protein (eGFP) driven by the astrocyte‐specific glial fibrillary acidic protein (GFAP) promoter was inserted into the safe harbor adeno‐associated virus integration site 1 (AAVS1) locus in disease and control‐derived iPSCs. Astrocyte populations were enriched using Fluorescence Activated Cell Sorting (FACS) and after enrichment more than 99% of iPS astrocytes expressed mature astrocyte markers including GFAP, S100β, NFIA and ALDH1L1. In addition, mature pure GFP‐iPS astrocytes exhibited a well‐described functional astrocytic activity in vitro characterized by neuron‐dependent regulation of glutamate transporters to regulate extracellular glutamate concentrations. Engraftment of GFP‐iPS astrocytes into rat spinal cord grey matter confirmed in vivo cell survival and continued astrocytic maturation. In conclusion, the generation of GFAP::GFP‐iPS astrocytes provides a powerful in vitro and in vivo tool for studying astrocyte biology and astrocyte‐driven disease pathogenesis and therapy. GLIA 2016;64:63–75     

Reduced heart rate variability in chronic severe traumatic brain injury: Association with impaired emotional and social functioning,and potential for treatment using biofeedback

Heart rate variability (HRV) may provide an index of capacity for social functioning and may be remediated by HRV biofeedback. Given reductions in HRV are found following traumatic brain injury (TBI), the present study aimed to determine whether lower HRV in TBI is associated with social function, and whether HRV biofeedback might be a useful remediation technique in this population. Resting state HRV and measures of social and emotional processing were collected in 30 individuals with severe TBI (3–34?years post-injury) and 30 controls. This was followed by a single session of HRV biofeedback. HRV was positively associated with social cognition and empathy, and negatively associated with alexithymia for the TBI group. Both TBI and control groups showed significantly increased HRV on both time-domain (i.e., SDNN, rMSSD) and frequency-domain measures (LF, HF, LF:HF ratio) during biofeedback compared to baseline. These results suggest that decreased HRV is linked to social and emotional function following severe TBI, and may be a novel target for therapy using HRV biofeedback techniques.     

Volumetric bone density at the femoral neck as a common measure of hip fracture risk for men and women

Measurements of bone density using dual-energy x-ray absorptiometry are generally based on the areal projection, which incompletely accounts for size. The larger areal bone density in older men compared with older women is primarily due to their larger bone size, conferring a biomechanical advantage that may be a major factor contributing to lower hip fracture rates. The aim of this study was to evaluate estimated volumetric bone density at the hip in men and women with and without fractures to better determine the role of estimated volumetric density vs. size in hip fracture risk. This prospective population-based study compared 852 women and 635 men without fractures with 73 women and 23 men with hip fractures. As expected, areal bone mineral density (BMD) and cross-sectional area were lower in women than men, and areal bone density was lower in those with hip fractures compared with nonfracture subjects. However, estimated volumetric BMD was the only parameter, apart from age, that was the same in women and men both without hip fractures (0.31 +/- 0.06 and 0.31 +/- 0.06 g/cm3, respectively) and with hip fractures (0.25 +/- 0.04 and 0.26 +/- 0.04 g/cm3, respectively). Using the World Health Organization 2.5 SD cut-off for osteoporosis for hip fracture prediction, estimated volumetric BMD was more sensitive than areal BMD in men (70 vs. 43%; P = 0.04) and similar to that in women, in whom sensitivity was similar for both areal (73%) and estimated volumetric (78%) BMD cut-offs. Thus, men and women have hip fractures at the same estimated femoral neck volumetric BMD, which is largely independent of the size artifact inherent in areal BMD. This aspect of estimated femoral neck volumetric BMD suggests that it can provide a single measure that could be used in men and women. It needs further exploration for a role in assessment of hip fracture risk across the sexes and particularly in men.     

Patient preference for time-saving telehealth postoperative visits after routine surgery in an urban setting

Background

Focusing on high-value delivery of health care, we describe our implementation of telephone postoperative visits as alternatives to in-person follow-up after routine, low-risk surgery in an urban setting. Our pilot program assessed telephone postoperative visit feasibility as well as patient satisfaction and clinical outcomes.

A comparison of nurses' needs/concerns and hospital disaster plans following Florida's Hurricane Floyd.

INTRODUCTION: The idea for this study was inspired by the response to Hurricane Floyd. Nurses are relied upon and expected to fulfill responsible roles during disaster situations, but little is known about the needs or concerns that nurses experience when they meet expectations and function as disaster responders. METHODS: Official copies of disaster protocols from 4 area hospitals were reviewed, and 4 focus groups consisting of ED nurses from respective hospitals provided information about nurses' concerns or needs in response to Hurricane Floyd. RESULTS: Of primary importance to nurses was family safety, pet care, and personal safety while at work. Secondary concerns were basic needs such as food, water, sleep, shelter, and rest. Group commitment levels to providing care during disaster situations varied greatly. Participants requested that hospital policy revisions address work assignments, pay/financial compensation, flexibility for extenuating circumstances, pet care, family sheltering, and provision of basic needs. DISCUSSION: It is not sufficient for a few key officials and planners to know their roles and responsibilities during a disaster; the roles of everyone involved must be clearly understood. Many participants described their conflict as family commitment versus professional obligation. We identified several areas of concerns in our interviews, and those areas have been clearly defined in the revised protocols. Other areas have yet to be addressed.