Nurses' Acceptance of and Satisfaction With the Advanced Cardiac Life Support Electronic Information System in Emergency Departments and Critical Care Units.

Emergency and critical care nurses perform an important role in documenting the resuscitation process. However, paper-based recording is labor intensive and complex and may result in incorrect recording of important parameters, which suggests the need for an appropriate electronic information system for emergency care. This cross-sectional descriptive study explores emergency and critical care nurses' acceptance of, and satisfaction with, the newly developed advanced cardiac life support electronic information system and examines whether paper-based recording and electronic recording approaches differ in the completeness of resuscitation records. Data were collected through a self-designed structured questionnaire and a retrospective review of medical records. Data were analyzed by descriptive statistics, independent sample t test, and one-way analysis of variance. The results indicated that novice nurses were more satisfied with the electronic information system than others. Emergency care nurses were significantly more satisfied than medical and surgical ICU nurses. The electronic information system improved the completeness of resuscitation recording by 23.5%, compared with the paper-based recording approach. Emergency and critical care nurses have a moderate to high degree of acceptance of, and satisfaction with, electronic information systems.

Effects of thoracic epidural anesthesia on cardiac function and myocardial cell apoptosis in isoproterenol-induced chronic heart failure rats.

OBJECTIVE: This study aimed to investigate the effects of thoracic epidural anesthesia (TEA) on cardiac function and myocardial cell apoptosis in isoproterenol (ISO) induced chronic heart failure (CHF) rats. METHOD: Rats were classified into 4 groups: the healthy control, ISO-induced CHF, ISO + TEA, and sham-treated groups. After 4 weeks, the animals in each group were examined by echocardiography. Invasive hemodynamic measurements were also preformed. RESULTS: Echocardiographic findings suggested that rats in the ISO + TEA group exhibited decreased left ventricular end-systolic (LVES) and left ventricular end-diastolic (LVED), and increased left ventricular ejection fraction (LVEF) and left ventricular shortening fraction (LVFS) compared with rats in the ISO-induced CHF group. Rats in the ISO + TEA group showed improved left ventricular systolic pressure (LVSP) and left ventricular end-diastolic pressure (LVEDP) compared with rats in the ISO-induced CHF group. Additionally, rats in the ISO + TEA group had significant decrease in LV and RV mass indexes (LVMI and RVMI) compared with rats in the ISO-induced CHF rats. Myocardial ultrastructure in the ISO + TEA group significantly improved compared with the ISO-induced CHF group. TEA significantly reduced the percent of TUNEL-positive cells in the ISO + TEA group compared with the ISO-induced CHF group. Compared with the ISO-induced CHF group, Bcl-2 expression of rats in the ISO + TEA group was significantly increased, while Bax expression was significantly attenuated. CONCLUSION: Our findings suggest that TEA may reduce myocardial apoptosis and decrease extent of structural damage and abnormalities in the myocardium.

Effects of high thoracic epidural anesthesia on atrial electrophysiological characteristics and sympathetic nerve sprouting in a canine model of atrial fibrillation.

High thoracic epidural anesthesia (HTEA) blocks the afferent and efferent cardiac sympathetic nerve fibers and may affect atrial electrophysiological characteristics and nerve sprouting in patients with atrial fibrillation (AF). In this study, 18 dogs were randomly divided into a control group (n = 6), in which dogs were atrially paced at 400 beats/min for 6 weeks; an HTEA group (n = 6), in which dogs underwent atrial pacing and HTEA for 6 weeks; and a sham-operated group (n = 6), in which dogs underwent the operation but did not receive atrial pacing or HTEA. Electrophysiological examinations were performed in all groups. Cardiac nerves were immunocytochemically stained with anti-growth-associated protein 43 (GAP43) and anti-tyrosine hydroxylase (TH) antibodies. The protein expressions of nerve growth factor (NGF), GAP43 and TH in atrial myocardium were also studied by western blot. In addition, the plasma levels of C-reactive protein (CRP) and norepinephrine, as well as atrial production of superoxide anion (O(2)(·-)) and malondialdehyde, were measured. In the HTEA group, atrial effective refractory period increased (P < 0.05) and AF maintenance decreased (P < 0.01) significantly compared with the control group. The densities of GAP43-positive nerves and TH-positive nerves were significantly lower in the HTEA group compared with the control group. The protein levels of NGF, GAP43 and TH were also lower in the HTEA group compared with the control group. A significant positive correlation between the expressions of NGF and GAP43 (P < 0.01) was observed. A similar correlation was demonstrated for NGF and TH (P < 0.01) in our study. Furthermore, the plasma levels of CRP and norepinephrine, as well as the amount of O(2)(·-) and malondialdehyde produced from myocardium, decreased in the HTEA group compared with the control group. In conclusion, HTEA inhibited electrical and nerve remodeling and reduced the maintenance of AF in a canine AF model, in which process HTEA exhibited anti-inflammatory and antioxidant effects, indicating that, in addition to the efferent cardiac sympathetic nerve, afferent fibers also play an important role in the initiation and/or maintenance of AF.

Expression of Laminin γ2 Proteolytic Fragments in Murine Skin Following Exposure to Sulfur Mustard.

Laminin-332 is a basement membrane protein composed of three genetically distinct polypeptide chains that actively promote both skin epidermal cell adhesion and migration. Proteolytic fragments of the laminin γ2 chain stimulate migration and scattering of keratinocytes and cancer cells. Sulfur mustard (SM) is a bifunctional alkylating agent that induces separation of basal keratinocytes from the dermal-epidermal junction and invokes a strong inflammatory response leading to delayed wound repair. In the present studies, the role of laminin γ2 in SM-induced skin injury and wound repair was investigated using the mouse ear vesicant model. We found that laminin γ2 chain mRNA was preferentially upregulated in mouse ear skin exposed to SM. In situ hybridization confirmed overexpression of laminin γ2 transcript. Western blot analysis showed increased protein expression of the full-length proform of laminin γ2 and smaller processed fragments of laminin γ2 in skin exposed to SM. Dual immunofluorescence labeling indicated that laminin γ2 fragments are prevalent in suprabasal keratinocytes behind the leading edge in areas of hyperplasia in injured skin. In addition, co-expression of laminin γ2 and the senescent marker, p16-INK4a was found to overlap with the hyperplastic migratory epithelial sheet. This observation is similar to hypermotile keratinocytes reported in invasive carcinoma cells. Overall, our studies indicate that laminin γ2 is preferentially expressed in skin post SM exposure and that protein expression appears to become progressively more fragmented. The laminin γ2 fragments may play a role in regulating SM-induced skin wound repair. Anat Rec, 2020. © 2020 American Association for Anatomy.

Cultural sensitivity and related factors among community health nurses.

BACKGROUND: Community health nurses are on the frontline of providing healthcare to multiethnic groups. Managing and providing effective, culture-specific healthcare can increase the health quality of Taiwan's recently immigrant women, a significant component of this country's population. PURPOSE: This study analyzes the cultural sensitivity of community health nurses and related factors. METHODS: A cross-sectional survey was applied in this study. Participants were nurses who work at health centers in Kaohsiung City and Pingtung County. A total of 230 valid questionnaires were completed. Structure questionnaires used in this study included (a) scale of nurses' cultural sensitivity, (b) scale of multicultural sources, (c) scale of multicultural competence training programs, and (d) table of personal characteristics. Statistical software SPSS 14.0 was used for statistical analysis. RESULTS: Survey results show an average score of community health nurse cultural sensitivity of 49.41 (SD = 7.48). The index score was 65.88. Thus, survey participants in this study earned a cultural sensitivity score below the index score. "Interaction confidence" earned the lowest item score. "Multicultural resources," "self-perceived English proficiency," "multicultural competence training programs," and "having friends with different cultural backgrounds" were significant predictor variables of cultural sensitivity and, together, explained 34.9% of total variance. CONCLUSIONS: Study results may be referenced in designing future in-service and cultural care education programs for community health nurses to improve healthcare quality for new immigrants.