Magnetic nanoparticles hyperthermia in a non-adiabatic and radiating process.

We investigate the magnetic nanoparticles hyperthermia in a non-adiabatic and radiating process through the calorimetric method. Specifically, we propose a theoretical approach to magnetic hyperthermia from a thermodynamic point of view. To test the robustness of the approach, we perform hyperthermia experiments and analyse the thermal behavior of magnetite and magnesium ferrite magnetic nanoparticles dispersed in water submitted to an alternating magnetic field. From our findings, besides estimating the specific loss power value from a non-adiabatic and radiating process, thus enhancing the accuracy in the determination of this quantity, we provide physical meaning to a parameter found in literature that still remained not fully understood, the effective thermal conductance, and bring to light how it can be obtained from experiment. In addition, we show our approach brings a correction to the estimated experimental results for specific loss power and effective thermal conductance, thus demonstrating the importance of the heat loss rate due to the thermal radiation in magnetic hyperthermia.

Induction of T-cell Immunity Overcomes Complete Resistance to PD-1 and CTLA-4 Blockade and Improves Survival in Pancreatic Carcinoma.

Disabling the function of immune checkpoint molecules can unlock T-cell immunity against cancer, yet despite remarkable clinical success with monoclonal antibodies (mAb) that block PD-1 or CTLA-4, resistance remains common and essentially unexplained. To date, pancreatic carcinoma is fully refractory to these antibodies. Here, using a genetically engineered mouse model of pancreatic ductal adenocarcinoma in which spontaneous immunity is minimal, we found that PD-L1 is prominent in the tumor microenvironment, a phenotype confirmed in patients; however, tumor PD-L1 was found to be independent of IFNγ in this model. Tumor T cells expressed PD-1 as prominently as T cells from chronically infected mice, but treatment with αPD-1 mAbs, with or without αCTLA-4 mAbs, failed in well-established tumors, recapitulating clinical results. Agonist αCD40 mAbs with chemotherapy induced T-cell immunity and reversed the complete resistance of pancreatic tumors to αPD-1 and αCTLA-4. The combination of αCD40/chemotherapy plus αPD-1 and/or αCTLA-4 induced regression of subcutaneous tumors, improved overall survival, and conferred curative protection from multiple tumor rechallenges, consistent with immune memory not otherwise achievable. Combinatorial treatment nearly doubled survival of mice with spontaneous pancreatic cancers, although no cures were observed. Our findings suggest that in pancreatic carcinoma, a nonimmunogenic tumor, baseline refractoriness to checkpoint inhibitors can be rescued by the priming of a T-cell response with αCD40/chemotherapy.

Assessment of inpatient treatment of patients with schizophrenia in Japan: implications for practice.

This descriptive study examined a stratified random sample by month of 202 persons with schizophrenia hospitalized on an inpatient unit at a nonprofit hospital located in Tokyo, Japan in 1998. This is one of the first studies reported that evaluates the inpatient care provided to persons with schizophrenia. The average length of stay was 107 days. The master treatment largely focused on medication management with other domains including daily observations and documentation of care not meeting the standard of care. Over 25% of the patients were in restraints during their hospitalization. Two patient deaths were reported. Problematic areas were patient teaching, monitoring of medication side effects, treatment planning, and discharge planning. The study site is fully accredited and attending physicians were all psychiatrists. How pervasive these deficiencies are in other settings is not known. The findings of the study were shared with the professional staff.

Development of quality of nursing care in Thailand.

BACKGROUND: In Thailand there is a need to establish definitions of quality of nursing care and to determine how it is measured. There is an urgent need to focus more closely on indicators of nursing quality. In Thailand there is no agreed upon definition of quality nursing care or indicators by which to measure it. PURPOSE: The purpose of this research was to develop a definition of quality of nursing care and to begin the process of defining quality of care indicator measures to evaluate the care given in acute care settings. METHODS: This descriptive study was conducted in Thailand. The process included two phases. The first phase used individual interviews and focus group discussion and the second phase included consultation with quality of nursing care experts. An interview guide was used to structure the interviews and the draft definitions of quality and suggested indicators were used when consulting with the experts in the second phase of the study. FINDINGS: The findings are organized into two sections: (1) definition of quality of nursing care and quality of nursing indicators; and (2) consultation with Thailand quality experts to refine the definition and quality of care indicators. The indicators were categorized into three groups: structure, process, and outcome. LIMITATIONS: This descriptive study using qualitative method relied upon the opinions of various stakeholders. Their opinions may or may not have any direct relationship to the scientific literature related to quality. Many of the indicators need to be further refined. CONCLUSIONS: The findings generally support the initial work done in the United States of America. There is a need to further refine the various Thailand indicators. This study is the first in Thailand that has attempted to address quality of nursing care.

Assessment of inpatient treatment of persons with schizophrenia: implications for practice.

This descriptive study examined a stratified random sample by month of 457 persons with schizophrenia hospitalized on an inpatient unit at a nonprofit hospital located in Honolulu, HI in 1997. White patients were overrepresented in the sample when compared to the number in the general population. Part-Hawaiian patients had longer lengths of stay. Women were more likely to be admitted involuntarily than men. The majority of the patients were prescribed atypical antipsychotic medications. Only 8.8% of the patients were in restraints during their hospitalization. Problematic areas were patient teaching, monitoring of medication side effects, treatment planning, and discharge planning. The study site is fully accredited, attending physicians were all psychiatrists, and the majority of the nurses were certified. How pervasive there deficiencies are in other settings is not known. The findings of the study were used to revise a schizophrenic care path used on the inpatient unit.

Making the transition to the perioperative clinical educator role.

Obtaining a desired position within the field of perioperative nursing can prove to be a daunting task. If one desires to become a perioperative clinical educator, the most logical place to start is to assume the role of a preceptor or mentor to novice nurses as they enter the field. Additionally, volunteering for committee work and participating in projects as they arise will demonstrate to perioperative leaders the skills and the ambition to advance. Furthermore, affiliation with professional nursing organizations will provide the networking resources and professional development tools that are needed for success.

Cross-cultural comparison of long-term psychiatric patients hospitalized in Tokyo, Japan and Honolulu, Hawaii.

The aim of this study is to cross-culturally explore the crucial and often conflicting issues of least restrictive placement of long-term psychiatric patients in Hawaii and Japan, and the need to provide high-quality care for such patients. Policy implications are discussed. A survey instrument facilitated the comparison of records from psychiatric patients hospitalized over 1 year in Hawaii, as of January 1993, and psychiatric patients hospitalized over 1 year in Japan, as of January 1996. The survey instrument was translated and validated for use in both countries. Interrater reliability averaged 0.96. The 30 subjects in Japan were all men (Japanese), and primarily unmarried. The 83 subjects in Hawaii were mostly men (Hawaiian or other ethnic minority), and unmarried. Subjects in Japan tended to be older, hospitalized longer, and were judged to be more dysfunctional than those in Hawaii. No significant relationship was revealed between nursing diagnoses and Axis I diagnoses in either sample. Although significant clinical differences were found between the two groups, the policy issues are similar: how to place patients in the least restrictive environment and how to provide high quality of care given the limited available resources. Nurses in both countries must become more vocal advocates for policy changes to improve the care of long-term patients.

Chart audit of inpatient treatment of schizophrenic patients: implications for development of coordinated care paths.

This study offers important information regarding the standard of care provided to schizophrenic patients treated at one inpatient facility. The findings were particularly useful in the development of a care path for this specific population. Areas for improvement identified in this research include medical tests, master treatment planning, documentation of care, patient teaching, and discharge planning. Given the limited health care dollars and the lack of a cure for schizophrenia, this research emphasizes the fact that treatment guidelines need to be aggressively tested as to their relevance to practice.

Staff nurse perceptions of health care system changes & nursing management models on client outcomes.

This investigation reports the results of a national survey of staff nurse perceptions of changes in the health care system and nursing management models on client outcomes.

Characteristics of long-term psychiatric patients hospitalized in Tokyo, Japan.

This study examined the records of all psychiatric patients hospitalized over 1 year who were committed as a result of a penal code violation at a public sector hospital located in Tokyo, Japan. The 30 patients were all men, Japanese, and primarily unmarried. Affective and organic disorders were totally absent. None of the new antipsychotic medications were used. There was no relationship between nursing diagnosis and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis. The demands for health care reform are beginning in Japan. Managing the integration of the long-term psychiatric patient into the community is one of the main challenges identified in this study.

Development of a scientifically valid coordinated care path.

OBJECTIVE: The goal of this study was to develop a method to scientifically create and validate a coordinated care path for use within any hospital setting. BACKGROUND: In an attempt to reduce the costs associated with high-volume and high-risk diagnosis, attention was focused on reducing patients' length of stay in the hospital. A method to reduce length of stay uses a coordinated care path. A path is a guideline used to manage the clinical care of selected patients. The literature is relatively silent regarding studies that have scientifically validated the use of these paths. METHODS: This project used a content validity method to validate the care path. Using current research findings, best practice standards both locally and nationally, a transdisciplinary team developed practice guidelines that included sequencing, timing of interventions, and expected patient outcomes. The path was rated by local and national experts using a four-point rating scale. Using Lynn's proportion of experts table computations, the validity of the path and each of its components was determined. RESULTS: Of 161 items on the care path, 10 were not validated. The experts validated the instrument as a whole. Of the 161 items, 151 were validated. This is an instrument validation rate of 0.94. No additional changes or modifications to the path were suggested by the experts. The transdisciplinary team addressed the nonvalidated items. This method can be used to develop other coordinated paths for other diagnostic groups.

Acute management of patients with hip fracture. A research literature review.

PURPOSE: To provide the orthopaedic nurse a summary of the significant research concerning the management of patients with a fractured hip. DESIGN: Meta-Analysis. SAMPLE: 135 articles reviewed for possible inclusion, 57 original research reports and publications are reported. METHODS: For the years 1985 to March 1996 Medline, MEDLARS, and CINAHL data bases were searched. Twenty-seven search terms were used, including hip fractured), orthopedic standards, and length of stay. MAIN RESEARCH CLASSIFICATIONS: Preoperative, Operative and Postoperative. Studies arranged by author, outcomes, focus, data source and year, sample, and findings. FINDINGS: Research reports were found concerning: preoperative care including the use of MRI, predictors of complications and transfusion needs, and impact of skin traction on pain; operative studies including spinal anesthesia and oxygen saturation rates, use of blankets to keep patient warm, prophylactic antibiotic use, and impact of delaying surgery; and postoperative reports including the incidence of DVT, nutritional status, cauterization, management protocols, morbidity and mortality risks, length of stay, functional status, and ambulation. CONCLUSION: The scientific merit of each study was not evaluated in depth. With some degree of comfort the review did find one study or several studies to support the findings presented. IMPLICATIONS FOR NURSING RESEARCH: Current research concerning the impact of pressure sores, incontinence, management of falls risk, and the impact the fear of falling on postinjury patients are just a few of the topics not adequately addressed.

Severely and persistently mentally ill in Hawaii: profile and implications.

This study examines the characteristics, treatment, and care of severely and persistently mentally ill clients at Hawaii's largest public-sector psychiatric facility, Hawaii State Hospital. The implications of this information are discussed in terms of treatment and care. As was found in previous studies, the 88 participants included in this study were mostly male, less than 40 years of age, with a high school education or less, and hospitalized under a penal code. More remarkable variations were revealed, however, when clients were grouped according to ethnicity and racial origin. For example, clients from marginalized groups had a significantly higher likelihood of violence than clients from more politically, economically, and socially powerful groups in Hawaii. The findings of this research challenge nurses to combine social advocacy with clinical expertise to provide effective and complete treatment and care.

Characteristics of long-term mentally ill patients: policy implications.

This study examined the records of all psychiatric patients who were hospitalized over one year in a public sector institution. The 88 patients primarily were men, hospitalized under a penal code, Hawaiian or other ethnic minority, and unmarried. Over 74% were hospitalized under a penal code. The State is moving toward a capitated managed care environment for the seriously and persistently mentally ill. With the majority of the patients who are hospitalized under a penal code, changes in the public policy concerning their care is needed. If no changes are made, all of the existing hospital beds potentially could be filled with forensic patients.

Competencies of new registered nurses: a survey of deans and health care agencies in the state of Hawaii.

In Hawaii, a survey of schools of nursing and health care agencies revealed significant differences in the perceived competencies of new registered nurse graduates. When directors of nursing were asked if new graduates meet expectations, more than 42% said no. This survey identifies that numerous discrepancies exist between agency expectations and what is actually practiced in the clinical setting. Suggestions for achieving competencies in both academic and agency settings are offered.

State university collaboration to transform practice in public sector psychiatric nursing.

In 1986 and again in 1988, Hawaii was ranked by the Torrey report as being 51st in the nation in caring for its persistent and seriously mentally ill. After several years of being ranked last in the nation, and with the threat of a consent decree from the U.S. Department of Justice, the state of Hawaii made a commitment to improve the psychiatric mental health care of its citizens. The state's Department of Health, in September 1990, contracted with the University of Hawaii's School of Nursing to provide joint appointment faculty to consult with the nursing staff and to provide the department's chief of nursing. Working together with the joint appointment faculty, the permanent staff began the journey toward creating a state-of-the-art facility. The article discusses how change of such magnitude has been created.