Implementing Evidence Informed Practice Changes: Barriers, Facilitators, and Work Environments.

OBJECTIVE: This study examined nurses' perspectives about the barriers and facilitators to implementing research findings and evidence into practice. BACKGROUND: Work environments play an essential role in implementation and innovation; however, much of the research regarding evidence-based practice focuses on nurses' knowledge and skills, leaving the work environments unexamined. METHODS: A mixed method survey design was used. Data collection included an electronic survey and open questions. Analysis included descriptive statistics and narrative analysis using the Consolidated Framework for Implementation Research. RESULTS: Attitudes about implementing evidence into practice were positive. Identified barriers included lack of time and knowledge, change fatigue, and complex internal processes; facilitators included supportive colleagues, knowledgeable mentors, and access to libraries and other resources. CONCLUSIONS: Implementing evidence into practice is facilitated by committing organizational resources, fostering supportive work environments, integrating evidence into quality improvement projects, offering continuing education, and reducing the complexity of translating evidence into practice and the number of institution-wide initiatives.

Stimulation of Metabolic Activity and Cell Differentiation in Osteoblastic and Human Mesenchymal Stem Cells by a Nanohydroxyapatite Paste Bone Graft Substitute.

Advances in nanotechnology have been exploited to develop new biomaterials including nanocrystalline hydroxyapatite (nHA) with physical properties close to those of natural bone mineral. While clinical data are encouraging, relatively little is understood regarding bone cells' interactions with synthetic graft substitutes based on this technology. The aim of this research was therefore to investigate the in vitro response of both osteoblast cell lines and primary osteoblasts to an nHA paste. Cellular metabolic activity was assessed using the cell viability reagent PrestoBlue and quantitative, real-time PCR was used to determine gene expression related to osteogenic differentiation. A potential role of calcium-sensing receptor (CaSR) in the response of osteoblastic cells to nHA was also investigated. Indirect contact of the nHA paste with human osteoblastic cells (Saos-2, MG63, primary osteoblasts) and human bone marrow-derived mesenchymal stem cells enhanced the cell metabolic activity. The nHA paste also stimulated gene expression of runt-related transcription factor 2, collagen 1, alkaline phosphatase, and osteocalcin, thereby indicating an osteogenic response. CaSR was not involved in nHA paste-induced increases in cellular metabolic activity. This investigation demonstrated that the nHA paste has osteogenic properties that contribute to clinical efficacy when employed as an injectable bone graft substitute.

Correction: Testing the potential of streamflow data to predict spring migration of ungulate herds.

[This corrects the article DOI: 10.1371/journal.pone.0262078.].

Testing the potential of streamflow data to predict spring migration of ungulate herds.

In mountainous and high latitude regions, migratory animals exploit green waves of emerging vegetation coinciding with rising daily mean temperatures initiating snowmelt across the landscape. Snowmelt also causes rivers and streams draining these regions to swell, a process referred to as to as the 'spring pulse.' Networks of streamgages measuring streamflow in these regions often have long-term and continuous periods of record available in real-time and at the daily time step, and thus produce data with potential to predict temporal migration patterns for species exploiting green waves. We tested the potential of models informed by streamflow data to predict timing of spring migration of mule deer (Odocoileus hemionus) herds in a headwater basin of the Colorado River. Models using streamflow data were compared with those informed by traditional temperature-derived measures of the onset of spring. Non-parametric linear-regression techniques were used to test for temporal stationarity in each variable, and logistic-regression models were used to produce probabilities of migration initiation. Our analysis indicates that models using daily streamflow data can perform as well as those using temperature-derived data to predict past-migration patterns, and nearly as well in potential to forecast future migrations. The best performing model was used to generate probabilities of onset of migration for mule deer herds over the 69-year period-of-record from a streamgage. That model indicated spring migration has been trending toward earlier initiations, with modeled median initiations shifting from a Julian day of 123 in the mid 20th century to Julian day 115 over the most recent two decades. The period of 1960 to 1979 had the latest modeled median initiations with Julian day of 128. The analyses demonstrate promise for merging existing hydrologic and biological data collection platforms in these regions to explore timing of past migration patterns and predict migration onsets in real-time.

Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants.

INTRODUCTION: Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language-proficient Latinx immigrants face additional challenges. METHODS: Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language-proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. RESULTS: Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent (n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men (n = 7) cited difficulty with excessive alcohol. CONSUMPTION: Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. CONCLUSION: Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.

Nanoscale Strontium-Substituted Hydroxyapatite Pastes and Gels for Bone Tissue Regeneration.

Injectable nanoscale hydroxyapatite (nHA) systems are highly promising biomaterials to address clinical needs in bone tissue regeneration, due to their excellent biocompatibility, bioinspired nature, and ability to be delivered in a minimally invasive manner. Bulk strontium-substituted hydroxyapatite (SrHA) is reported to encourage bone tissue growth by stimulating bone deposition and reducing bone resorption, but there are no detailed reports describing the preparation of a systematic substitution up to 100% at the nanoscale. The aim of this work was therefore to fabricate systematic series (0-100 atomic% Sr) of SrHA pastes and gels using two different rapid-mixing methodological approaches, wet precipitation and sol-gel. The full range of nanoscale SrHA materials were successfully prepared using both methods, with a measured substitution very close to the calculated amounts. As anticipated, the SrHA samples showed increased radiopacity, a beneficial property to aid in vivo or clinical monitoring of the material in situ over time. For indirect methods, the greatest cell viabilities were observed for the 100% substituted SrHA paste and gel, while direct viability results were most likely influenced by material disaggregation in the tissue culture media. It was concluded that nanoscale SrHAs were superior biomaterials for applications in bone surgery, due to increased radiopacity and improved biocompatibility.

A Review Into the Effects of Pamidronic Acid and Zoledronic Acid on the Oral Mucosa in Medication-Related Osteonecrosis of the Jaw.

Medication-related osteonecrosis of the jaw (MRONJ) is a growing problem without an effective treatment, presenting as necrotic bone sections exposed via lesions in the overlying soft tissue. There is currently a lack of clarity on how the factors involved in MRONJ development and progression contribute to disease prognosis and outcomes. Bisphosphonates (BPs), the most common cause of MRONJ, affect bone remodeling, angiogenesis, infection, inflammation and soft tissue toxicity, all of which contribute to MRONJ development. This article reviews the cellular mechanisms through which BPs contribute to MRONJ pathology, with a focus on the effects on cells of the oral mucosa. BPs have been shown to reduce cell viability, reduce proliferation, and increase apoptosis in oral keratinocytes and fibroblasts. BPs have also been demonstrated to reduce epithelial thickness and prevent epithelial formation in three-dimensional tissue engineered models of the oral mucosa. This combination of factors demonstrates how BPs lead to the reduced wound healing seen in MRONJ and begins to uncover the mechanisms through which these effects occur. The evidence presented here supports identification of targets which can be used to develop novel treatment strategies to promote soft tissue wound healing and restore mucosal coverage of exposed bone in MRONJ.

Creating Microclimates of Change: Transparency in Disseminating Nursing Quality Performance Data.

OBJECTIVES: Study objectives were to: 1) explore how nursing care quality data (NCQD) was understood and interpreted; and 2) identify, compare, and contrast individual and group responses. BACKGROUND: Little evidence exists on how to best disseminate NCQD information. This study explores the outcomes of implementing an NCQD and human-interest information slide show across an inpatient surgery nursing service line using electronic screens. METHODS: Methods included semistructured interviews, qualitative analysis, and diagramming. RESULTS: The human-interest content most often attracted viewers' attention, but they were also exposed to NCQD. Interpretations and understandings differed among groups and between individuals. Among staff members, the human-interest content facilitated team-building, whereas NCQD provided meaningful recognition. Nursing care quality data evidenced the efforts that were being made to improve and provide excellent patient care. CONCLUSIONS: Using innovative dissemination methods can enhance understanding of NCQD among clinical providers. Creating microclimates of change and innovation within complex healthcare environments can benefit staff members and patients.

Magnet® and Pathway to Excellence®: Focusing on Research and Evidence-Based Practice.

Healthcare organizations seeking to achieve or maintain Magnet or Pathway to Excellence designation are increasingly challenged to demonstrate how nurses are leading or are engaged in research and evidence-based practice. This article describes common barriers to and effective strategies for developing a culture of research and evidence-based practice, with recommendations for Magnet- and Pathway-seeking organizations.

Evaluation of reproducibility of the chemical solubility of dental ceramics using ISO 6872:2015.

STATEMENT OF PROBLEM: The current chemical solubility method in the International Standards Organization (ISO) 6872 (2015) specifies only the total surface area of specimens for testing (≥30 cm2) but does not describe the morphology or geometry. This could impact the reproducibility of the test outcomes. PURPOSE: The purpose of this in vitro study was to investigate the factors influencing the reliability of the ISO 6872:2015 "Dentistry-Ceramic materials" test for chemical solubility. MATERIAL AND METHODS: Chemical solubility analysis of a range of materials and specimen geometries was performed in accordance with ISO 6872:2015. Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP), VITABLOCS Mark II, IPS e.max Press, and IPS e.max ZirPress materials were formed into a range of cubic and spherical geometries to comply with the 30-cm2 minimum surface area requirement. The surface microstructure of the specimens was analyzed using a scanning electron microscope, inductively coupled plasma optical emission spectrometry (ICP-OES) was used to analyze the solutes, and surface hardness of the specimens was measured by using a Vickers hardness tester before and after testing. An optimized solubility test was devised, which eliminated specimen handling once the specimens had been ground and polished. This modified test was performed on VITABLOCS Mark II and Y-TZP. RESULTS: The results of the original chemical solubility method of ISO 6872:2015 showed significantly variable findings for each tested material, with a predictable relationship between geometry and chemical solubility. The hardness values decreased significantly after the solubility testing. The optimized method showed significantly improved reproducibility of the chemical solubility measurement compared with the original ISO 6872:2015 test. CONCLUSIONS: The results of the current chemical solubility standard method can be manipulated while still complying with the ISO 6872:2015 standard.

The Space Between: Transformative Learning and Type 2 Diabetes Self-Management.

INTRODUCTION: Immigrant populations experience higher type 2 diabetes mellitus (T2DM) prevalence rates and worse health outcomes secondary to T2DM than native-born populations. But as the largest immigrant population in the United States, the experience of T2DM diagnosis and self-management among Spanish-speaking, limited English-language proficient Latinx immigrants remains largely unexamined. This study used semistructured interviews to explore these phenomena among a cohort of 30 recent Latinx immigrants. METHOD: All aspects of data collection were conducted in Spanish. Quantitative and qualitative data were collected. Data analysis included descriptive statistical procedures. Qualitative data analysis was conducted using a grounded theory approach. RESULTS: Patterns in the data analysis of 30 interviews identified accepting T2DM as a common transitional process that required significant changes in individuals' self-perspective and ways of being. Accepting T2DM was identified by the participants as a precursor to treatment initiation. And while for most participants this transition period was brief, for some it took months to years. Distinct transitional stages were identified, categorized, and considered within the context of several theoretical orientations and were observed to align with those in transformative learning. CONCLUSION: Understanding differing responses and processing of a T2DM diagnosis could be leveraged to better support patients' acceptance and transition into treatment.

Nurses' Short Peripheral Catheter Flushing Practices: Implications for Patient Care, Nursing Education, and Policy.

Nursing practice and institutional policies regarding short peripheral catheter (SPC) flushing vary. These variations result in a lack of understanding about the factors that influence nurses' SPC flushing practices and leave their effect on outcomes unexplored-information that could potentially enhance nurses' clinical education, institutional policy efforts, and patient care. Using a mixed-methods design, this study examined SPC flushing practices and outcomes among a cohort of medical-surgical nurses and explored their rationale for flushing. Trends were noted in the timing of flushes, and the factors that influenced nurses' SPC flushing practices included patient acuity, experience, and workload.

Reactive Inkjet Printing of Regenerated Silk Fibroin Films for Use as Dental Barrier Membranes.

Current commercially available barrier membranes for oral surgery have yet to achieve a perfect design. Existing materials used are either non-resorbable and require a second surgery for their extraction, or alternatively are resorbable but suffer from poor structural integrity or degrade into acidic by-products. Silk has the potential to overcome these issues and has yet to be made into a commercially available dental barrier membrane. Reactive inkjet printing (RIJ) has recently been demonstrated to be a suitable method for assembling silk in its regenerated silk fibroin (RSF) form into different constructs. This paper will establish the properties of RSF solutions for RIJ and the suitability of RIJ for the construction of RSF barrier membranes. Printed RSF films were characterised by their crystallinity and surface properties, which were shown to be controllable via RIJ. RSF films degraded in either phosphate buffered saline or protease XIV solutions had degradation rates related to RSF crystallinity. RSF films were also printed with the inclusion of nano-hydroxyapatite (nHA). As reactive inkjet printing could control RSF crystallinity and hence its degradation rate, as well as offering the ability to incorporate bioactive nHA inclusions, reactive inkjet printing is deemed a suitable alternative method for RSF processing and the production of dental barrier membranes.

Evaluating the Efficacy and Use of Vein Visualization Equipment Among Clinical Nurses in an Intermediate Care Environment.

This study compared traditional short peripheral catheter (SPC) insertion methods with 2 vein visualization equipment models among a general patient population on a surgical step-down unit based on first-attempt success rates and the time required to achieve catheter insertion. The experiences of clinical nurses using the ultrasound and vein visualization equipment were also explored. No significant statistical differences were found between the insertion methods, based on 90 unique SPC insertion attempts. However, nurses reported that using the vein visualization equipment informed patient care, facilitated communication among members of the health care team, and facilitated second SPC insertion attempts. Nursing staff also used the equipment more often after the study concluded.

Maintaining Short Peripheral Catheter Patency: A Comparison of Saline Lock Versus Continuous Infusion in the Acute Care Setting.

Sparse evidence exists about how short peripheral catheter (SPC) duration is affected by the presence of a saline lock versus continually infusing fluids. Often the choice to lock an SPC with saline is based on provider preference, rather than available evidence or patient-centered factors. This study compared the duration of 85 SPCs: locked with saline versus continuously running fluids. A secondary analysis considered the influence of a number of intermittent medications and flushes. Although the saline-locked group had a slightly longer duration time, it was not statistically significant. Factors such as desire to ambulate or nighttime saline flushes merit consideration in SPC care decisions and standardized nurse-driven protocols.

Assessing nurses' adherence to a central line maintenance care checklist on a pediatric inpatient unit.

Adherence to evidence-based central line maintenance practices remains a challenge, particularly in complex patient populations. Using an evidence-based observational checklist, areas of nonadherence were identified and a focused educational intervention was developed, resulting in improved adherence across all aspects of the central line maintenance care bundle.

Diabetes affects everything: Type 2 diabetes self-management among Spanish-speaking hispanic immigrants.

This article is a report of qualitative findings of a mixed-methods study of the relationships among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes mellitus (T2DM) self-management among limited-english-proficient recent Hispanic immigrants, a population with increased incidence of T2DM and barriers to successful T2DM management. Semi-structured interviews were conducted with 30 participants, and physiological and demographic data also were collected. The participants generally attributed developing the disease to strong emotions and viewed T2DM as a serious disease. Although a majority understood the importance of exercise and diet in T2DM self-management, other aspects such as medication adherence were not well-understood. Obstacles to effective T2DM self-management were negative interactions and communications with health care providers and other personnel, cultural stigma related to the disease, financial constraints, immigration status, and the complexity of the disease. Suggested interventions to improve the care and self-management of this at-risk population are discussed.

Rapid Mix Preparation of Bioinspired Nanoscale Hydroxyapatite for Biomedical Applications.

Hydroxyapatite (HA) has been widely used as a medical ceramic due to its good biocompatibility and osteoconductivity. Recently there has been interest regarding the use of bioinspired nanoscale hydroxyapatite (nHA). However, biological apatite is known to be calcium-deficient and carbonate-substituted with a nanoscale platelet-like morphology. Bioinspired nHA has the potential to stimulate optimal bone tissue regeneration due to its similarity to bone and tooth enamel mineral. Many of the methods currently used to fabricate nHA both in the laboratory and commercially, involve lengthy processes and complex equipment. Therefore, the aim of this study was to develop a rapid and reliable method to prepare high quality bioinspired nHA. The rapid mixing method developed was based upon an acid-base reaction involving calcium hydroxide and phosphoric acid. Briefly, a phosphoric acid solution was poured into a calcium hydroxide solution followed by stirring, washing and drying stages. Part of the batch was sintered at 1,000 °C for 2 h in order to investigate the products' high temperature stability. X-ray diffraction analysis showed the successful formation of HA, which showed thermal decomposition to ß-tricalcium phosphate after high temperature processing, which is typical for calcium-deficient HA. Fourier transform infrared spectroscopy showed the presence of carbonate groups in the precipitated product. The nHA particles had a low aspect ratio with approximate dimensions of 50 x 30 nm, close to the dimensions of biological apatite. The material was also calcium deficient with a Ca:P molar ratio of 1.63, which like biological apatite is lower than the stoichiometric HA ratio of 1.67. This new method is therefore a reliable and far more convenient process for the manufacture of bioinspired nHA, overcoming the need for lengthy titrations and complex equipment. The resulting bioinspired HA product is suitable for use in a wide variety of medical and consumer health applications.

Multilayer Nanoscale Encapsulation of Biofunctional Peptides to Enhance Bone Tissue Regeneration In Vivo.

Bone tissue healing is a dynamic process that is initiated by the recruitment of osteoprogenitor cells followed by their migration, proliferation, differentiation, and development of a mineralizing extracellular matrix. The work aims to manufacture a functionalized porous membrane that stimulates early events in bone healing for initiating a regenerative cascade. Layer-by-layer (LbL) assembly is proposed to modify the surface of osteoconductive electrospun meshes, based on poly(lactic-co-glycolic acid) and nanohydroxyapatite, by using poly(allylamine hydrochloride) and poly(sodium 4-styrenesulfonate) as polyelectrolytes. Molecular cues are incorporated by grafting peptide fragments into the discrete nanolayers. KRSR (lysine-arginine-serine-arginine) sequence is grafted to enhance cell adhesion and proliferation, NSPVNSKIPKACCVPTELSAI to guide bone marrow mesenchymal stem cells differentiation in osteoblasts, and FHRRIKA (phenylalanine-histidine-arginine-arginine-isoleucine-lysine-alanine) to improve mineralization matrix formation. Scanning electron microscopy, infrared spectroscopy, and X-ray photoelectron spectroscopy demonstrate the successful surface functionalization. Furthermore, the peptide incorporation enhances cellular processes, with good viability and significant increase of alkaline phosphatase activity, osteopontin, and osteocalcin. The functionalized membrane induces a favorable in vivo response after implantation for four weeks in nonhealing rat calvarial defect model. It is concluded that the multilayer nanoencapsulation of biofunctional peptides using LbL approach has significant potential as innovative manufacturing technique to improve bone regeneration in orthopedic and craniofacial medical devices.