Recommendations After an Objective Structured Clinical Examination Program Evaluation.

BACKGROUND: The use of objective structured clinical examinations (OSCEs) is a well-established method of clinical assessment in the medical profession, and these are currently being integrated into advanced practice nursing curricula. METHOD: A program assessment was conducted at a current family nurse practitioner track within a southwestern U.S. university using the OSCE evaluative strategy. The logic model from the Centers for Disease Control and Prevention framework was incorporated. Both focus group and the de-identified faculty-scored student rubrics during the fall, spring, and summer semesters of one cohort of students (N = 73) were examined. RESULTS: Strengths and challenges were found in the areas of student preparation, scoring/grading with variations of inter-rater reliability, and debriefing. CONCLUSION: Establishing a specific OSCE center with a dedicated director could support adequate attainment of formative and summative competencies for nurse practitioners and provide faculty education and standardized student preparation, while adhering to the multiple guidelines and standards related to nurse practitioner competency evaluation with simulation. [J Contin Educ Nurs. 2023;54(4):169-175.].

The engagement of orthopaedic surgeons in diabetic foot care in England.

AIMS: Diabetic foot care is a significant burden on the NHS in England. We have conducted a nationwide survey to determine the current participation of orthopaedic surgeons in diabetic foot care in England. METHODS: A questionnaire was sent to all 136 NHS trusts audited in the 2018 National Diabetic Foot Audit (NDFA). The questionnaire asked about the structure of diabetic foot care services. RESULTS: Overall, 123 trusts responded, of which 117 admitted patients with diabetic foot disease and 113 had an orthopaedic foot and ankle surgeon. A total of 90 trusts (77%) stated that the admission involved medicine, with 53 (45%) of these admissions being exclusively under medicine, and 37 (32%) as joint admissions. Of the joint admissions, 16 (14%) were combined with vascular and 12(10%) with orthopaedic surgery. Admission is solely under vascular surgery in 12 trusts (10%) and orthopaedic surgery in 7 (6%). Diabetic foot abscesses were drained by orthopaedic surgeons in 61 trusts (52%) and vascular surgeons in 47 (40%). CONCLUSION: Orthopaedic surgeons make a significant contribution to both acute and elective diabetic foot care currently in the UK. This contribution is likely to increase with the movement of vascular surgery to a hub and spoke model, and measures should be put in place to increase the team based approach to the diabetic foot, for example with the introduction of a best practice tariff.Cite this article: Bone Jt Open 2022;3(8):618-622.

The importance of the early appropriate management of foot and ankle soft tissue sarcomas - experiences of a regional sarcoma service.

INTRODUCTION: Soft tissue sarcomas (STS) are a group of rare malignant tumours that can occur at almost any anatomical location in patients of any age, which often present to health care professional working outside a recognised sarcoma service. A review of foot and ankle STSs was conducted, reporting on patient and tumour characteristics, and patient outcome following surgery performed within and outside our sarcoma service. PATIENTS AND METHODS: A retrospective review of all foot and ankle STSs managed by our sarcoma service over a 14 year period was performed. Patient demographics, tumour characteristics, management and patient outcomes including recurrence rates and survival were analysed. RESULTS: Twenty-six patients were analysed (16F:10M) with a mean age of 57.7 years (range 17-87). The mean follow-up was 6.3 years (range 1-16). Sixteen tumours involved the foot, nine the ankle, and one spanned the foot and ankle. Mean tumour size was 4.3 cm (range 0.8-15), although 61% of cases were smaller than 4 cm, and almost one third of cases smaller than 1 cm. Seven of 26 (27%) cases were diagnosed after an unplanned excision performed by non sarcoma surgeons. These patients were more likely to undergo an incomplete tumour excision (p < 0.001), suffer local recurrence (p = 0.001), and eventually undergo a secondary amputation (p = 0.034) than those patients managed exclusively by a sarcoma service. Overall, 12 (46%) patients died of their disease during follow up, equating to a five-year survival rate of 69%. CONCLUSION: Our data shows that unplanned excisions continue to be performed on foot and ankle STSs, and that these have detrimental effects on patients. Despite this, our results also show that these complex patients can be managed successfully when referred appropriately to a sarcoma service, prior to any surgical treatment. This highlights the importance of vigilance amongst all health care professionals managing any foot or ankle lumps, regardless of their size.

Do degree of coronal plane deformity and patient related factors affect union and outcome of Arthroscopic versus Open Ankle Arthrodesis?

BACKGROUND: This study aimed to analyse if union and outcome of Arthroscopic Ankle Arthrodesis (AAA) versus Open Ankle Arthrodesis (OAA) were influenced by the extent of coronal plane deformity and to report if patient related factors influence union. METHODS: A total of 122 ankle arthrodesis procedures were included in the study. These were divided into two groups; Group A (n = 99) with deformity less than 15° and Group B (n = 23) with deformity greater than or equal to 15°. Data was collected on patient demographics, medical comorbidities (smoking, diabetes, obesity) and time to union. Patient reported outcome measures (PROMs) evaluated were Manchester Oxford Foot Questionnaire, EuroQol-5D and EuroQol visual analogue health thermometer (EQ-VAS). RESULTS: The mean follow-up in Group A and B was 74.87 and 89.17 months respectively. The average deformity in Group A was 4.9° for AAA and 5.8° for OAA. In Group B it was 18.9° (maximum 28° varus) for AAA and 22.1° (maximum 41° valgus) for OAA. The overall union rate was 95% in Group A (AAA-94%; OAA-100%; [p = 0.20]) and 87% in Group B (AAA-100%; OAA-67%; [p = 0.02]). Mean time to union was 13.2 weeks in Group A (AAA-13.3 weeks; OAA-12.8 weeks; [p = 0.73]) compared to 12.4 weeks for Group B (AAA-12.9 weeks; OAA-11.8 weeks; [p = 0.56]). Irrespective of the extent of deformity and type of surgery, smokers had a 10 times higher likelihood of non-union (p = 0.03). In Group A, none of the PROMs showed significant difference between AAA and OAA. In Group B, EQ-VAS score reached statistical significance (p = 0.03) in favour of AAA whereas other PROMs showed no difference. CONCLUSION: AAA is reproducible in achieving union in end stage ankle arthritis and good PROMs can be expected even in ankles with larger deformities. Regardless of the type of surgery and extent of deformity, smoking is a significant risk factor for non-union. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Cell spinpods are a simple inexpensive suspension culture device to deliver fluid shear stress to renal proximal tubular cells.

Rotating forms of suspension culture allow cells to aggregate into spheroids, prevent the de-differentiating influence of 2D culture, and, perhaps most importantly of all, provide physiologically relevant, in vivo levels of shear stress. Rotating suspension culture technology has not been widely implemented, in large part because the vessels are prohibitively expensive, labor-intensive to use, and are difficult to scale for industrial applications. Our solution addresses each of these challenges in a new vessel called a cell spinpod. These small 3.5 mL capacity vessels are constructed from injection-molded thermoplastic polymer components. They contain self-sealing axial silicone rubber ports, and fluoropolymer, breathable membranes. Here we report the two-fluid modeling of the flow and stresses in cell spinpods. Cell spinpods were used to demonstrate the effect of fluid shear stress on renal cell gene expression and cellular functions, particularly membrane and xenobiotic transporters, mitochondrial function, and myeloma light chain, cisplatin and doxorubicin, toxicity. During exposure to myeloma immunoglobulin light chains, rotation increased release of clinically validated nephrotoxicity cytokine markers in a toxin-specific pattern. Addition of cisplatin or doxorubicin nephrotoxins reversed the enhanced glucose and albumin uptake induced by fluid shear stress in rotating cell spinpod cultures. Cell spinpods are a simple, inexpensive, easily automated culture device that enhances cellular functions for in vitro studies of nephrotoxicity.

Capturing the Impact of the Doctor of Nursing Practice Degree on West Texas Health Care.

BACKGROUND: This article describes findings from a Phase 1 investigation exploring the influence of Doctor of Nursing Practice (DNP)-prepared nurses in West Texas. METHOD: Following a focus group session with eight practicing DNPs, the focus group shared how their roles effected safer health care. RESULTS: Final takeaways included their commitment to safer health care and prevention, moving care to the community, and a wish for more variety in projects generated in workplaces. Three themes emerged from the data: DNP leadership practice affects health outcomes through improved quality of care, influence, and innovation; DNP strengths include communication, leadership, and ability to change others' thinking; and the influence of DNP-prepared leaders at all external levels occurs through both increasing awareness of the role and influencing in multiple areas. DNP challenges include lack of understanding by others of the role and the lack of recognition and respect for their educational preparation. CONCLUSION: Leading, innovating, and communicating during constantly changing care models are key skills needed during the current health care crisis. These skills are basic to DNP practice. [J Contin Educ Nurs. 2021;52(4):192-197.].

Effect of a 5-HT7 Receptor Antagonist on Reversal Learning in the Rat Attentional Set-Shifting Test.

5-HT7 receptor antagonism has been shown to ameliorate ketamine-induced schizophrenia-like deficits in extradimensional set-shifting using the attentional set-shifting task (ASST). However, this rodent paradigm distinguishes between several types of cognitive rigidity associated with neuropsychiatric conditions. The goal of this study was to test 5-HT7 receptor involvement in the reversal learning component of the ASST because this ability depends primarily on the orbito-frontal cortex, which shows strong 5-HT7 receptor expression. We found that impaired performance on the ASST induced by NMDA receptor blockade (MK-801, 0.2 mg/kg) in 14 rats was reversed by coadministration of the 5-HT7 receptor antagonist SB-269970. The strongest effect was found on the reversal phases of ASST, whereas injection of SB-269970 alone had no effect. These results indicate that 5-HT7 receptor mechanisms may have a specific contribution to the complex cognitive deficits, increasing perseverative responding, in psychiatric diseases, including schizophrenia, depression, and anorexia nervosa, which express different forms of cognitive inflexibility.

Educational Revolution: Integrating Concept-Based Curriculum and Active Learning for Mental Health Nursing Students.

OBJECTIVE: To disseminate knowledge to mental health nurse educators regarding a course that is successfully preparing registered nurse (RN) students to pass the psychosocial integrity portion of the National Council Licensing Exam for Registered Nurses (NCLEX-RN). METHOD: Following the implementation of a new concept-based nursing program curricular design, faculty teaching in a psychiatric mental health nursing course embarked on converting lecture-based, content-saturated teaching strategies into active learning strategies. In this article, the overall conceptual framework for the course and specific examples of active learning teaching strategies related to nursing concepts in mental health are described. Information on objectives, clinical placements, testing, class organization, and curricular content are provided. Outcomes are shared revealing success in helping students pass the psychosocial integrity section of the NCLEX-RN. RESULTS: Predictive scores on the HESI RN Psychiatric Mental Health Specialty Exam have been consistently higher than the national average for the United States, and the NCLEX-RN pass rate for the cohort of 90 students was 97%. The majority of student evaluations of the course were positive. CONCLUSIONS: Results suggest that the integration of conceptual and active learning in a psychiatric mental health nursing course may increase the likelihood of student success.

Vitamin D and foot and ankle trauma: An individual or societal problem.

BACKGROUND: Vitamin D deficiency is a worldwide health concern. Hypovitaminosis D may adversely affect recovery from bone injury. The authors aimed to perform an audit of the Vitamin D status of patients in three centres in the United Kingdom presenting with foot and ankle osseous damage. METHODS: Serum 25-hydroxyvitamin-D (vitamin D) levels were obtained in patients presenting with imaging confirmed foot and ankle osseous trauma. Variables including age, gender, ethnicity, location, season, month, anatomical location and type of bone injury were recorded. RESULTS: 308 patients were included from three different centres. 66.6% were female. The average age was 47.7 (range; 10-85). The mean hydroxyvitamin-D levels were 52.0 nmol/L (SD 28.5). 18.8% were grossly deficient, 23.7% deficient, 34.7% insufficient and 22.7% within normal range. 351 separate bone injuries were identified of which 104 were categorised as stress reactions, 134 as stress fractures, 105 as fractures and 8 non-unions. Age, gender, anatomical location and fracture type did not statistically affect vitamin D levels. Ethnicity did affect Vitamin D levels: non-Caucasians mean levels were 32.4 nmols/L compared to Caucasian levels of 53.2 nmol/L (p=0.0026). CONCLUSION: Only 18.8% of our trauma patients had a normal Vitamin D level and 22.7% were grossly deficient. Patient age, gender, anatomical location and injury type did not statistically affect vitamin D levels. No difference between trauma and elective patients were found. Hypovitaminosis D is a problem of society in general rather than specific to certain foot and ankle injury patterns or particular patient groups sustaining trauma. LEVEL OF EVIDENCE: 2b.

Exploring the Perspectives of Telecommuting Nursing Faculty.

BACKGROUND: This study explored the needs of faculty telecommuters for a school of nursing, as well as other programs considering employing telecommuters in the future. METHOD: This was a qualitative descriptive study using content analysis and quantitative demographics. After institutional review board approval was obtained, the study was conducted using a convenience sample of telecommuting nursing faculty from one university. The participants responded to open-ended survey questions describing their experience of telecommuting and provided demographic data. RESULTS: Social interaction was key, especially from faculty who initially were in full-time on-campus positions. How social contact is maintained determined overall success in this role. Factors helping included online meetings, online social interactions, positive reports of flexibility, and experienced high levels of autonomy. A Nursing Faculty Telecommuter Interactional Model for Success was created based on these themes. CONCLUSION: Technology appeared to be the driving force of productive work days. [J Nurs Educ. 2019;58(3):152-159.].

A concept analysis of health literacy.

AIM: To propose a conceptual definition of health literacy incorporating system demands, burdens, and complexities that are a critical part of patients' level of health literacy. BACKGROUND: Health literacy is used frequently in health care and often is confused with patients' reading and comprehension levels. DESIGN: Walker and Avant's concept analysis method was used. DATA SOURCE: Cochrane Library, Cumulative Index of Nursing and Health Literature, OVID, PubMed, EBSCO Host databases, and Google Scholar. REVIEW METHOD: The primary Search terms and MeSH terms used were health literacy, patient education, patient engagement, patient activation, health communication, health promotion, and nursing. Empirical and nonempirical articles published in English were reviewed. Ten systematic literature reviews were included. RESULTS: A new definition of health literacy is provided based on four components that include: system demands, burdens, and complexities; measurable components, processes and outcomes; the dynamic nature of health literacy; and demonstration of the direct relationship of informed decisions to informed actions. Defining attributes, antecedents, and consequences are identified. Implications for nursing practice, education, and research are given. CONCLUSIONS: Because health literacy is a dynamic and quickly changing concept, further exploration and evolution of the concept is warranted as empirical research and theoretical literature emerge.

Vitamin D levels in 577 consecutive elective foot & ankle surgery patients.

BACKGROUND: Vitamin D deficiency is a global concern impacting upon large communities and certain disease populations. It can adversely affect the outcome of orthopaedic operations. We aimed to perform an audit of the Vitamin D status of patients in two centres in the United Kingdom undergoing elective foot and ankle surgery. METHODS: Serum 25-hydroxyvitamin-D (vitamin D) levels were obtained prospectively in 577 consecutive elective patients undergoing elective foot and ankle surgery between October 2014 and March 2017 (29 months). Variables including age, gender, ethnicity, location, season, month and procedure type were recorded. RESULTS: 577 patients were included over the study period. 62.0% were female. Mean age was 53.2 (median 54.5, range 16.7-86.6). 300 patients were treated in Northampton and 277 in Leicester. The serum 25-hydroxyvitamin-D levels for the patient group were normally distributed. The mean was 52.3nmol/L (SD 28.0; range 7.5-175) and the median 47.5nmol/L. 21.7% were grossly deficient, 31.9% deficient, 28.9% insufficient and 17.5% within normal range. Age, gender and procedure type did not statistically affect vitamin D levels (p=0.5, t-test). Ethnicity, location and Winter season did affect Vitamin D levels (p<0.05). August was the most significant month with levels significantly higher than January, February, March, April, June, November and December (p<0.05, one-way ANOVA). CONCLUSIONS: Only 1 in 5.7 patients had a normal Vitamin D level and 1 in 4.6 were grossly deficient. Ethnicity and patient location significantly affected Vitamin D results. Summer months were noted to demonstrate significantly the highest levels and August the highest. We did not find that age or gender affected Vitamin D levels in our cohort.

Effects of Space Flight on Mouse Liver versus Kidney: Gene Pathway Analyses.

Understanding genome wide, tissue-specific, and spaceflight-induced changes in gene expression is critical to develop effective countermeasures. Transcriptome analysis has been performed on diverse tissues harvested from animals flown in space, but not the kidney. We determined the genome wide gene expression using a gene array analysis of kidney and liver tissue from mice flown in space for 12 days versus ground based control animals. By comparing the transcriptome of liver and kidney from animals flown in space versus ground control animals, we tested a unique hypothesis: Are there common gene expression pathways activated in multiple tissue types in response to spaceflight stimuli? Although there were tissue-specific changes, both liver and kidney overexpressed genes in the same four areas: (a) cellular responses to peptides, hormones, and nitrogen/organonitrogen compounds; (b) apoptosis and cell death; (c) fat cell differentiation and (d) negative regulation of protein kinase.

Actualizing veterans education in nursing.

A grant driven partnership among a west Texas university, Texas Workforce Commission's College Credits for Heroes, and the Health Resources and Services Administration provided the funding needed to create a competency based education (CBE) model for recognizing military veteran service training and experience. Through this model, we call Competency Assessment Placement (CAP), prior learning credits can be awarded for upper division nursing courses leading to a Bachelor of Science in Nursing. The process used by faculty to create this direct assessment method for awarding credit, performance data of Cohort I using the CAP, and our initial "lessons learned" are provided. Incorporating an on-going reflection of military veteran student learning needs, a persistent concern for improvement of the nursing program, as well as a frequent review of veteran educational benefit policies will continue as this CAP model provides beneficial outcomes for the students.

Health Literacy: Essential for a Culture of Health.

BACKGROUND: A culture of health requires a commitment from all-individuals, families, communities, organizations, and municipalities-to value health and make decisions reflective of a healthy society. At the individual level, health literacy is a necessary precursor to assist individuals in achieving a higher level of health. METHOD: One method for ensuring that staff members are routinely assessing and promoting health literacy is using competencies and practices previously identified for all health professions. RESULTS: Cross-walking these competencies with the Health Literacy Tapestry model can be extremely helpful in framing assessment, action steps, and outcomes for nurses. CONCLUSION: Professional development nurse leaders have the challenge of ensuring that nurses are addressing patient health literacy as a fundamental nursing activity in every nursing-patient-family interaction. Assuming health literacy deficits as a "universal approach" to care is one method of ensuring health literacy needs are routinely addressed by staff. J Contin Educ Nurs. 2018;49(2):73-78.

Physical Forces Modulate Oxidative Status and Stress Defense Meditated Metabolic Adaptation of Yeast Colonies: Spaceflight and Microgravity Simulations.

Baker's yeast (Saccharomyces cerevisiae) has broad genetic homology to human cells. Although typically grown as 1-2mm diameter colonies under certain conditions yeast can form very large (10 + mm in diameter) or 'giant' colonies on agar. Giant yeast colonies have been used to study diverse biomedical processes such as cell survival, aging, and the response to cancer pharmacogenomics. Such colonies evolve dynamically into complex stratified structures that respond differentially to environmental cues. Ammonia production, gravity driven ammonia convection, and shear defense responses are key differentiation signals for cell death and reactive oxygen system pathways in these colonies. The response to these signals can be modulated by experimental interventions such as agar composition, gene deletion and application of pharmaceuticals. In this study we used physical factors including colony rotation and microgravity to modify ammonia convection and shear stress as environmental cues and observed differences in the responses of both ammonia dependent and stress response dependent pathways We found that the effects of random positioning are distinct from rotation. Furthermore, both true and simulated microgravity exacerbated both cellular redox responses and apoptosis. These changes were largely shear-response dependent but each model had a unique response signature as measured by shear stress genes and the promoter set which regulates them These physical techniques permitted a graded manipulation of both convection and ammonia signaling and are primed to substantially contribute to our understanding of the mechanisms of drug action, cell aging, and colony differentiation.