Knowledge development, technology and questions of nursing ethics.

This article explores emerging ethical questions that result from knowledge development in a complex, technological age. Nursing practice is at a critical ideological and ethical precipice where decision-making is enhanced and burdened by new ways of knowing that include artificial intelligence, algorithms, Big Data, genetics and genomics, neuroscience, and technological innovation. On the positive side is the new understanding provided by large data sets; the quick and efficient reduction of data into useable pieces; the replacement of redundant human tasks by machines, error reduction, pattern recognition, and so forth. However, these innovations require skepticism and critique from a profession whose mission is to care for and protect patients. The promise of technology and the new biological sciences to radically and positively transform healthcare may seem compelling when couched in terms of safety, efficiency, and effectiveness but their role in the provision of ethical nursing care remains uncertain. Given the profound moral and clinical implications of how today's knowledge is developed and utilized, it is time to reconsider the relationship between ethics and knowledge development in this new uncharted area.

Heat shock protein 60 involvement in vascular smooth muscle cell proliferation.

AIM: Heat shock protein 60 (Hsp60) is a mediator of stress-induced vascular smooth muscle cell (VSMC) proliferation. This study will determine, first, if the mitochondrial or cytoplasmic localization of Hsp60 is critical to VSMC proliferation and, second, the mechanism of Hsp60 induction of VSMC proliferation with a focus on modification of nucleocytoplasmic trafficking. METHODS AND RESULTS: Hsp60 was overexpressed in primary rabbit VSMCs with or without a mitochondrial targeting sequence (AdHsp60mito-). Both interventions induced an increase in VSMC PCNA expression and proliferation. The increase in VSMC PCNA expression and growth was not observed after siRNA-mediated knockdown of Hsp60 expression. Nuclear protein import in VSMC was measured by fluorescent microscopy using a microinjected fluorescent import substrate. Nuclear protein import was stimulated by both AdHsp60 and AdHsp60mito- treatments. AdHsp60 treatment also induced increases in nucleoporin (Nup) 62, Nup153, importin-α, importin-ß and Ran expression as well as cellular ATP levels compared to control. AdHsp60mito- treatment induced an up-regulation in importin-α, importin-ß and Ran expression compared to control. Hsp60 knockdown did not change nuclear protein import nor the expression of any nuclear transport receptors or nucleoporins. Both heat shock treatment and Hsp60 overexpression promoted the interaction of Ran with Hsp60. CONCLUSIONS: VSMC proliferation can be modulated via an Hsp60 dependent, cytosol localized mechanism that in part involves a stimulation of nuclear protein import through an interaction with Ran. This novel cellular signaling role for Hsp60 may be important in growth-based vascular pathologies like atherosclerosis and hypertension.

Rapid recovery following cardiac surgery: a nursing perspective.

Fast track or rapid-recovery pathways following cardiac surgery are becoming common practice in many cardiac units in order to maximize use of scarce critical care resources. Within the UK, rapid recovery generally describes same-day discharge from the initial intensive care facility to a lower-dependency unit. There are no nationally agreed protocols to help guide this practice. In a London teaching hospital a nurse-led audit was undertaken to identify which patients were selected for rapid recovery and to evaluate safety (length of hospital stay and incidences of postoperative complications) compared to a conventional recovery pathway. The study also sought to gain insight into the patients' views on rapid recovery. Data were collected on 104 patients, all patients (n = 56) who followed a rapid-recovery pathway were included. A comparison group (n = 48) was selected from patients who followed a conventional recovery but who were eligible for rapid recovery. The primary outcome, median length of hospital stay was 6 days for both groups, but the rapid-recovery group experienced significantly fewer postoperative complications. Rapid recovery as currently practised on this unit is safe for carefully selected cardiac surgical patients but barriers to rapid recovery need to be explored.