Sharing intellectual and social capital: A partnership to advance informatics and foster consumer centric care.

The need to educate the nursing workforce about using informatics tools to provide safe, quality consumer centric care is of utmost importance. A unique and strategic partnership was established to address this challenge. The informatics specialty option at the University of Colorado at Denver and Health Sciences Center School of Nursing has joined forces with McKesson Corporation. The overall goal of this partnership is to provide leadership in the field of nursing informatics and the further development of nursing informatics as a discipline. This paper describes the converging forces that serve as a foundation for the partnership. There are also descriptions of the two partners and their shared goals. This partnership was designed to share intellectual and social capital to advance nursing informatics through educational and research opportunities. The partnership also allows for the use of intellectual capital to brainstorm new developments, designs and to test the usability of new products. This paper reports on the various projects underway in the area of education, scholarship, research and development.

Teaching nurses to provide patient centered evidence-based care through the use of informatics tools that promote safety, quality and effective clinical decisions.

Schools of Nursing face the challenge of providing students with experiences to use evidence-based consumer centric care information tools. To facilitate this challenge, a unique partnership was forged between a school of nursing and a leading clinical information systems corporation. This strategic partnership was created to advance the field of nursing informatics through the sharing of intellectual capital. Through this sharing, the goal is to study how technology can promote patient safety, support evidence-based care and facilitate consumer involvement in health care decisions. This paper describes the design, development and testing of a multimedia product that can be used by schools of nursing. This product can be integrated into a nursing curriculum to promote the use of informatics tools as an integral practice component. The multimedia product embraces the core competencies advocated by the Institute of Medicine's Health Professions Education Report.

Relationship between cardiovascular risk factors and atherosclerotic disease burden measured by intravascular ultrasound.

OBJECTIVES: The goal of this study was to determine the relationship between established cardiovascular risk factors and the extent of coronary atherosclerotic plaque. BACKGROUND: Few data exist correlating cardiovascular risk factors with volumetric measurements of coronary atheroma burden in patients with coronary artery disease. METHODS: Clinical characteristics, quantitative coronary angiography, and intravascular ultrasound (IVUS) were evaluated in subjects enrolled in a study comparing atorvastatin and pravastatin. Plaque areas were measured at 1-mm intervals to compute atheroma volume. The percent of cross sections with an abnormal intimal thickness (>0.5 mm) was determined. Data on cardiovascular risk factors were collected. RESULTS: In 654 subjects, atheroma volume averaged 174.5 mm3 and percent atheroma volume 38.9%. Atherosclerosis was present in 81.2% of 25,897 cross sections. In univariate analysis, there was a strong association between diabetes, male gender, and a history of either prior revascularization or stroke with percent atheroma volume. Hypertension or prior myocardial infarction was also predictive of more severe disease. Low-density lipoprotein and C-reactive protein were not significant predictors of greater disease burden. In multivariate analysis, diabetes, male gender, and a history of a prior interventional procedure remained strong predictors of increased atheroma volume. History of stroke, non-Caucasian race, and smoking status remained significant. Although multiple measures of IVUS disease burden were worse in subjects with diabetes, angiographic stenosis severity was not different. CONCLUSIONS: Male gender, diabetes, and a history of prior revascularization are strong independent predictors of atherosclerotic burden in coronary disease patients. Many risk factors did not predict angiographic disease severity, suggesting different mechanisms drive stenosis development and atheroma accumulation.

Communication, coordination and knowledge sharing in the implementation of CPOE: impact on nursing practice.

The implementation of CPOE has transformed the delivery of healthcare. It has also significantly impacted nursing practice by refocusing the role of nurses in direct patient care. These changes have highlighted the vital role that nurses play in communication, coordination and knowledge sharing. CPOE has the potential to maximize productivity and contribute to improved patient safety and improved work environment for nurses.

New approach to the statistical analysis of cardiovascular data.

Fourier-based approaches to analysis of variability of R-R intervals or blood pressure typically compute power in a given frequency band (e.g., 0.01-0.07 Hz) by aggregating the power at each constituent frequency within that band. This paper describes a new approach to the analysis of these data. We propose to partition the blood pressure variability spectrum into more narrow components by computing power in 0.01-Hz-wide bands. Therefore, instead of a single measure of variability in a specific frequency interval, we obtain several measurements. The approach generates a more complex data structure that requires a careful account of the nested repeated measures. We briefly describe a statistical methodology based on generalized estimating equations that suitably handles this more complex data structure. To illustrate the methods, we consider systolic blood pressure data collected during psychological and orthostatic challenge. We compare the results with those obtained using the conventional methods to compute blood pressure variability, and we show that our approach yields more efficient results and more powerful statistical tests. We conclude that this approach may allow a more thorough analysis of cardiovascular parameters that are measured under different experimental conditions, such as blood pressure or heart rate variability.

Pharmacokinetics of a nicotine polacrilex lozenge.

To evaluate the pharmacokinetic characteristics of the 2-mg and 4-mg nicotine polacrilex lozenges, the following four separate studies were conducted in healthy adult smokers: (a) A single-dose, four-way crossover (replicate design) study to compare the 4-mg lozenge and the 4-mg nicotine polacrilex gum, (b) a single-dose, two-way crossover study to compare the 2-mg lozenge and the 2-mg gum, (c) a multiple-dose, four-way crossover study to compare the lozenges administered every 90 min and the gums administered every 60 min at 2- and 4-mg dose levels, and (d) a single-dose, three-way crossover study to compare the pharmacokinetic profiles of the 4-mg lozenge when administered in three different ways: (i) Used as directed, (ii) chewed and immediately swallowed, and (iii) chewed, retained in the mouth for 5 min, and then swallowed. The single-dose studies consistently demonstrated 8%-10% higher maximal plasma concentrations and 25%-27% higher AUC values (area under the concentration-time curve) from the lozenges compared with the gums at the 2- and 4-mg dose levels, probably owing to the residual nicotine retained in the gum. The multiple-dose study applying different dosing intervals (i.e., every 90 min for the lozenges and every 60 min for the gums) resulted in approximately 30% lower AUC(0-t) values for the lozenges compared with those for the gums. Administration of the lozenge contrary to the label-specified instructions for use did not lead to a faster or higher absorption of nicotine. These pharmacokinetic characteristics should allow the lozenge to become an effective and safe therapeutic alternative for smoking cessation.

Leadership in the digital age: a framework to balance high touch with high tech.

The next great age will be influenced heavily by the physical sciences, biological sciences, and nanotechnologies. This article presents case scenarios highlighting the technologic possibilities for the next age. It also presents a potential leadership model for the digital age and beyond. Finally, it provides insight as to how nurse managers can reconcile one of the major dilemmas in nursing--balancing "high touch" with "high tech."