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1.
Issues Ment Health Nurs ; : 1-5, 2024 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-38900995

RESUMEN

BACKGROUND: The use of high-fidelity simulators (manikins) and standardized patients (SPs) in simulation has been incorporated into many nursing schools throughout the nation to augment the clinical rotation experience. There is little to no data available on comparing undergraduate students' preferences between SPs and manikins in psychiatric nursing. METHODS: A quantitative descriptive exploratory design was used to evaluate pre-licensure nursing students' preferences in both traditional 4-year Bachelor of Science in Nursing (BSN) and accelerated BSN programs (ABSN). RESULTS: Overall, students preferred having an SP over a manikin to learn how to properly perform a nursing assessment on a psychiatric patient. CONCLUSIONS: Standardized patients offer a more realistic experience when assessing various domains of the mental status examination and when practicing therapeutic communication techniques in psychiatric nursing. The growth of SP training programs should be fostered. Well-trained SPs are an asset to simulation, especially in psychiatric nursing.

2.
BJOG ; 130(10): 1269-1274, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37039253

RESUMEN

OBJECTIVE: Direct current cardioversion (DCCV) in pregnancy is rarely required and typically only documented in single case reports or case series. A recent UK confidential enquiry reported on several maternal deaths where appropriate DCCV appeared to have been withheld. DESIGN: Retrospective cohort study. SETTING: Seventeen UK and Ireland specialist maternity centres. SAMPLE: Twenty-seven pregnant women requiring DCCV in pregnancy. MAIN OUTCOME MEASURES: Maternal and fetal outcomes following DCCV. RESULTS: Twenty-seven women had a total of 29 DCCVs in pregnancy. Of these, 19 (70%) initial presentations were to Emergency Departments and eight (30%) to maternity settings. There were no maternal deaths. Seventeen of the women (63%) had a prior history of heart disease. Median gestation at DCCV was 28 weeks, median gestation at delivery was 35 weeks, with a live birth in all cases. The abnormal heart rhythms documented at the first cardioversion were atrial fibrillation in 12/27 (44%) cases, atrial flutter in 8/27 (30%), supraventricular tachycardia in 5/27 (19%) and atrial tachycardia in 2/27 (7%). Fetal monitoring was undertaken following DCCV on 14/29 (48%) occasions (10 of 19 (53%) at ≥26 weeks) and on 2/29 (7%) occasions, urgent delivery was required post DCCV. CONCLUSIONS: Direct current cardioversion in pregnancy is rarely required but should be undertaken when clinically indicated according to standard algorithms to optimise maternal wellbeing. Once the woman is stable post DCCV, gestation-relevant fetal monitoring should be undertaken. Maternity units should develop multidisciplinary processes to ensure pregnant women receive the same standard of care as their non-pregnant counterparts.


Asunto(s)
Fibrilación Atrial , Cardiopatías , Humanos , Femenino , Embarazo , Cardioversión Eléctrica , Resultado del Tratamiento , Estudios Retrospectivos
3.
Int J Nurs Educ Scholarsh ; 20(1)2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36632680

RESUMEN

OBJECTIVES: The purpose of this study was to explore nursing students' experiences after completing community health nursing simulation encounters. METHODS: The study used a descriptive qualitative design. Through conventional content analysis, the research team analyzed the experiences of 73 nursing students after participating in community health nursing simulation encounters. The data come from nursing students' responses to three post-simulation qualitative questions. RESULTS: Nursing students identified both positive aspects (simulation as a great learning method, useful in understanding community health nurses' roles, faculty's role in facilitating an effective learning environment) and opportunities for improvement (needing for clear objectives, expectations, and roles). CONCLUSIONS: Community health nursing simulation encounters can be a powerful educational method to help students experience and understand the roles of community health nurses. IMPLICATIONS FOR INTERNATIONAL AUDIENCE: Augmentation of the pre-brief component will further improve students' simulation experiences.


Asunto(s)
Enfermería en Salud Comunitaria , Bachillerato en Enfermería , Estudiantes de Enfermería , Humanos , Bachillerato en Enfermería/métodos , Aprendizaje , Competencia Clínica , Investigación Cualitativa
4.
Genesis ; 59(7-8): e23438, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34124835

RESUMEN

Cilia on neurons play critical roles in both the development and function of the central nervous system (CNS). While it remains challenging to elucidate the precise roles for neuronal cilia, it is clear that a subset of G-protein-coupled receptors (GPCRs) preferentially localize to the cilia membrane. Further, ciliary GPCR signaling has been implicated in regulating a variety of behaviors. Melanin concentrating hormone receptor 1 (MCHR1), is a GPCR expressed centrally in rodents known to be enriched in cilia. Here we have used MCHR1 as a model ciliary GPCR to develop a strategy to fluorescently tag receptors expressed from the endogenous locus in vivo. Using CRISPR/Cas9, we inserted the coding sequence of the fluorescent protein mCherry into the N-terminus of Mchr1. Analysis of the fusion protein (mCherry MCHR1) revealed its localization to neuronal cilia in the CNS, across multiple developmental time points and in various regions of the adult brain. Our approach simultaneously produced fortuitous in/dels altering the Mchr1 start codon resulting in a new MCHR1 knockout line. Functional studies using electrophysiology show a significant alteration of synaptic strength in MCHR1 knockout mice. A reduction in strength is also detected in mice homozygous for the mCherry insertion, suggesting that while the strategy is useful for monitoring the receptor, activity could be altered. However, both lines should aid in studies of MCHR1 function and contribute to our understanding of MCHR1 signaling in the brain. Additionally, this approach could be expanded to aid in the study of other ciliary GPCRs.


Asunto(s)
Melaninas/metabolismo , Neuronas/metabolismo , Receptores de Somatostatina/metabolismo , Alelos , Animales , Cilios/metabolismo , Homocigoto , Ratones , Ratones Endogámicos C57BL , Neuronas/fisiología , Receptores de Somatostatina/genética , Sinapsis/metabolismo , Sinapsis/fisiología , Potenciales Sinápticos
5.
J Neurosci Res ; 99(3): 827-842, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33175436

RESUMEN

The neural mechanisms that underlie responses to drugs of abuse are complex, and impacted by a number of neuromodulatory peptides. Within the past 10 years it has been discovered that several of the receptors for neuromodulators are enriched in the primary cilia of neurons. Primary cilia are microtubule-based organelles that project from the surface of nearly all mammalian cells, including neurons. Despite what we know about cilia, our understanding of how cilia regulate neuronal function and behavior is still limited. The primary objective of this study was to investigate the contributions of primary cilia on specific neuronal populations to behavioral responses to amphetamine. To test the consequences of cilia loss on amphetamine-induced locomotor activity we selectively ablated cilia from dopaminergic or GAD2-GABAergic neurons in mice. Cilia loss had no effect on baseline locomotion in either mouse strain. In mice lacking cilia on dopaminergic neurons, locomotor activity compared to wild- type mice was reduced in both sexes in response to acute administration of 3.0 mg/kg amphetamine. In contrast, changes in the locomotor response to amphetamine in mice lacking cilia on GAD2-GABAergic neurons were primarily driven by reductions in locomotor activity in males. Following repeated amphetamine administration (1.0 mg kg-1  day-1 over 5 days), mice lacking cilia on GAD2-GABAergic neurons exhibited enhanced sensitization of the locomotor stimulant response to the drug, whereas mice lacking cilia on dopaminergic neurons did not differ from wild-type controls. These results indicate that cilia play neuron-specific roles in both acute and neuroplastic responses to psychostimulant drugs of abuse.


Asunto(s)
Anfetamina/farmacología , Estimulantes del Sistema Nervioso Central/farmacología , Cilios/efectos de los fármacos , Cilios/patología , Actividad Motora/efectos de los fármacos , Animales , Cilios/genética , Dopamina , Neuronas Dopaminérgicas/patología , Femenino , Masculino , Ratones , Ratones Noqueados , Plasticidad Neuronal
6.
J Community Health Nurs ; 38(3): 139-150, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34148430

RESUMEN

Purpose: To expose students to various public health roles and complement clinical experience using simulated encounters.Design: This exploratory study assessed students' performance of basic nursing tasks for three public health nurse roles.Methods: 15-guided questions were used to evaluate a convenience sample of 137 students' expected performance compared to their actual performance of basic nursing skills.Findings: Students' performed well in all nurse roles with some significant differences in completing a few critical tasks in the case manager and school nurse roles.Conclusion: Simulation can address gaps in nursing programs and expose student nurses to various public health roles using real-life scenarios.Clinical Evidence: Lack of clinical sites in public health limits students' experience to a myriad of nurse functions within communities.


Asunto(s)
Salud Pública/normas , Estudiantes de Enfermería/estadística & datos numéricos , Actitud del Personal de Salud , Bachillerato en Enfermería/métodos , Bachillerato en Enfermería/normas , Bachillerato en Enfermería/estadística & datos numéricos , Evaluación Educacional/métodos , Florida , Humanos , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Entrenamiento Simulado/métodos , Entrenamiento Simulado/estadística & datos numéricos , Estudiantes de Enfermería/psicología
7.
Public Health Nurs ; 37(4): 596-601, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32462693

RESUMEN

OBJECTIVE: Public health nursing courses typically incorporate clinical components but rarely offer simulation education as part of clinical practice. There is limited research examining the impact of simulation for public health nursing courses on final exam scores. The objective of this study was to determine the impact of simulation training on final exam scores in a public health nursing course. DESIGN: Public health scenarios were created to provide hands-on experience in two settings. Home and school environments were used with discussion of students' performance during debriefing. SAMPLE: Using a convenience sample, final exam scores were compared between nursing students (n = 79) who participated in a public health nursing simulation and two similar student groups (n = 97) that did not participate in simulation. RESULTS: Students with simulation training scored higher in both public health domains (Community Health; Clinical Prevention and Population Health). A significant difference in total mean final scores (p = .04; p = .02) was noted between groups of students with simulation training and those without. CONCLUSION: The difference in mean final scores suggests that simulation may be an effective educational modality in preparing students toward their state board or end of semester exams.


Asunto(s)
Evaluación Educacional/estadística & datos numéricos , Enfermería en Salud Pública/educación , Entrenamiento Simulado , Curriculum , Bachillerato en Enfermería/organización & administración , Humanos , Aprendizaje , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Estudiantes de Enfermería/psicología
8.
Anesth Analg ; 129(6): 1557-1560, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31743175

RESUMEN

BACKGROUND: Anesthesia providers' hand hygiene practices in the operating room may contribute to the transmission of bacteria. There is a debate, however, over the best approaches for pathogen containment during task dense periods (induction and extubation) of anesthesia care. A novel approach to reducing pathogen spread during these task dense periods is the use of alcohol-based hand rub on gloves when it may be difficult to either change gloves or clean hands. METHODS: To evaluate the impact of alcohol-based hand rub on gloves, we estimated perforation rates of 50 gloves that were worn as pairs by volunteers for 2 hours at a time applying alcohol-based hand rub every 15 minutes (total of 8 alcohol-based hand rub applications per pair of gloves). We also identified perforation rates of 50 new, unused gloves. To evaluate the ability to perform routine anesthesia functions, volunteers were asked to pick up a coin from a table top and document whether the gloves felt normal or sticky at each 15-minute period. RESULTS: Fifty new gloves (not exposed to alcohol-based hand rub) were tested for integrity using the Food and Drug Administration-approved process, and one was found to have a microperforation. Of the 50 gloves that had been applied with alcohol-based hand rub 8 times, no microperforations were identified. All volunteers demonstrated tactile competence by picking up a coin from a table top after 8 alcohol-based hand rub applications; in addition, as the number of alcohol-based hand rub applications progressed, the volunteers reported increased stickiness. CONCLUSIONS: This study suggests that the use of alcohol-based hand rub on commonly used nitrile examination gloves does not compromise glove integrity or hamper the ability to safely perform routine anesthesia functions.


Asunto(s)
Anestesiólogos , Contaminación de Equipos/prevención & control , Etanol , Guantes Quirúrgicos , Desinfección de las Manos/métodos , Desinfectantes para las Manos , Control de Infecciones/métodos , Quirófanos , Actitud del Personal de Salud , Falla de Equipo , Etanol/efectos adversos , Guantes Quirúrgicos/efectos adversos , Desinfectantes para las Manos/efectos adversos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Ensayo de Materiales , Pautas de la Práctica en Medicina , Percepción del Tacto
9.
Anesth Analg ; 129(6): e182-e184, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31743176

RESUMEN

Anesthesia providers have the burden of constant hand hygiene during task dense periods. The requirement for hand hygiene often demands frequent application of alcohol-based hand rub. To assess whether frequent alcohol-based hand rub use leads to skin changes or irritant contact dermatitis, volunteers cleaned their hands with alcohol-based hand rub every 15 minutes for 8 hours for 5 sequential days. They were examined by a dermatologist before and after and asked about subjective skin changes. Results suggest an increase in irritant contact dermatitis scores and subjective complaints.


Asunto(s)
Anestesiólogos/normas , Dermatitis por Contacto/etiología , Dermatitis Profesional/etiología , Adhesión a Directriz/normas , Desinfección de las Manos/normas , Desinfectantes para las Manos/efectos adversos , Control de Infecciones/métodos , Exposición Profesional/efectos adversos , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina/normas , Dermatitis por Contacto/diagnóstico , Dermatitis Profesional/diagnóstico , Humanos , Quirófanos/normas , Distribución Aleatoria , Medición de Riesgo , Factores de Riesgo , Organización Mundial de la Salud
10.
J Cardiovasc Electrophysiol ; 28(12): 1485-1491, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28833764

RESUMEN

The autonomic nervous system plays an important role in the genesis of atrial fibrillation and is one of the candidate targets for atrial fibrillation therapy. This review focuses on the role of the autonomic nervous system in atrial fibrillation development and discusses the results of the ganglionated plexi catheter and surgical ablation in preclinical and clinical studies. The heart is innervated by the extrinsic and intrinsic autonomic nervous systems. The intrinsic autonomic nervous system consists of multiple ganglionated plexi and axons, which innervate the neighboring atrial myocardium and control their electrophysiological properties. Abnormal autonomic innervation has been observed in an animal model of atrial fibrillation and in humans. Direct recordings of autonomic nerve activity in canine models showed that atrial tachyarrhythmia episodes were invariably preceded by intrinsic cardiac autonomic nerve activity, thus supporting the importance of intrinsic cardiac autonomic nerve activity as the triggers for atrial tachyarrhythmia. Targeting ganglionated plexi with catheter ablation improves the outcomes of paroxysmal atrial fibrillation ablation in addition to pulmonary vein antrum isolation. Ablation of ganglionated plexi alone without pulmonary vein isolation is also useful in controlling paroxysmal atrial fibrillation in some patients. However, surgical ganglionated plexi ablation in patients with a large left atrium, persistent atrial fibrillation, and/or a history of prior catheter ablation does not result in additional benefits. These different outcomes suggest that ganglionated plexi ablation is effective in managing patients with paroxysmal atrial fibrillation, but its effects in patients with persistent atrial fibrillation and advanced atrial diseases might be limited.


Asunto(s)
Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Ganglios Autónomos/fisiopatología , Animales , Sistema de Conducción Cardíaco/fisiopatología , Sistema de Conducción Cardíaco/cirugía , Humanos , Neurotransmisores/fisiología
11.
Curr Hypertens Rep ; 19(3): 20, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28271419

RESUMEN

PURPOSE OF REVIEW: Pre-eclampsia remains a leading worldwide cause of maternal death and of perinatal morbidity. There remains no definitive treatment except delivery of the fetus. RECENT FINDINGS: Recent insights into the cardiovascular changes that are evident prior to, during, and persist after pre-eclampsia have improved understanding of the underlying pathophysiology-disruption of normal endothelial function and decreased nitric oxide bioavailability. S-nitrosoglutathione (GSNO) is an endogenous S-nitrosothiol that acts as a NO pool and, by replenishing or preventing the breakdown of GSNO, endothelial dysfunction can be ameliorated. GSNO reductase inhibitors are a novel class of drug that can increase NO bioavailability. GSNO reductase inhibitors have demonstrated improvement of endothelial dysfunction in animal models, and in vivo human studies have shown them to be well tolerated. GSNOR inhibitors offer a potentially promising option for the management of pre-eclampsia.


Asunto(s)
Inhibidores Enzimáticos/uso terapéutico , Preeclampsia/tratamiento farmacológico , S-Nitrosoglutatión/antagonistas & inhibidores , Animales , Endotelio/efectos de los fármacos , Endotelio/metabolismo , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Óxido Nítrico/metabolismo , Embarazo
12.
Circulation ; 132(15): 1377-86, 2015 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-26362634

RESUMEN

BACKGROUND: Hypokalemia increases the vulnerability to ventricular fibrillation. We hypothesize that the apamin-sensitive small-conductance calcium-activated potassium current (IKAS) is activated during hypokalemia and that IKAS blockade is proarrhythmic. METHODS AND RESULTS: Optical mapping was performed in 23 Langendorff-perfused rabbit ventricles with atrioventricular block and either right or left ventricular pacing during normokalemia or hypokalemia. Apamin prolonged the action potential duration (APD) measured to 80% repolarization (APD80) by 26 milliseconds (95% confidence interval [CI], 14-37) during normokalemia and by 54 milliseconds (95% CI, 40-68) during hypokalemia (P=0.01) at a 1000-millisecond pacing cycle length. In hypokalemic ventricles, apamin increased the maximal slope of APD restitution, the pacing cycle length threshold of APD alternans, the pacing cycle length for wave-break induction, and the area of spatially discordant APD alternans. Apamin significantly facilitated the induction of sustained ventricular fibrillation (from 3 of 9 hearts to 9 of 9 hearts; P=0.009). Short-term cardiac memory was assessed by the slope of APD80 versus activation time. The slope increased from 0.01 (95% CI, -0.09 to 0.12) at baseline to 0.34 (95% CI, 0.23-0.44) after apamin (P<0.001) during right ventricular pacing and from 0.07 (95% CI, -0.05 to 0.20) to 0.54 (95% CI, 0.06-1.03) after apamin infusion (P=0.045) during left ventricular pacing. Patch-clamp studies confirmed increased IKAS in isolated rabbit ventricular myocytes during hypokalemia (P=0.038). CONCLUSIONS: Hypokalemia activates IKAS to shorten APD and maintain repolarization reserve at late activation sites during ventricular pacing. IKAS blockade prominently lengthens the APD at late activation sites and facilitates ventricular fibrillation induction.


Asunto(s)
Estimulación Cardíaca Artificial , Sistema de Conducción Cardíaco/fisiopatología , Hipopotasemia/fisiopatología , Canales de Potasio de Conductancia Intermedia Activados por el Calcio/fisiología , Potasio/fisiología , Fibrilación Ventricular/etiología , Potenciales de Acción/efectos de los fármacos , Animales , Apamina/farmacología , Estimulación Cardíaca Artificial/efectos adversos , Susceptibilidad a Enfermedades , Sistema de Conducción Cardíaco/efectos de los fármacos , Ventrículos Cardíacos/fisiopatología , Hipopotasemia/complicaciones , Canales de Potasio de Conductancia Intermedia Activados por el Calcio/antagonistas & inhibidores , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/fisiología , Técnicas de Placa-Clamp , Bloqueadores de los Canales de Potasio/farmacología , Conejos , Fibrilación Ventricular/fisiopatología , Fibrilación Ventricular/prevención & control , Imagen de Colorante Sensible al Voltaje
13.
Appl Nurs Res ; 30: 94-7, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27091261

RESUMEN

INTRODUCTION: The purpose of this study was to identify the impact of high-fidelity simulation on the retention of basic life support cardiopulmonary resuscitation (CPR) knowledge among a group of healthcare providers (HCPs). METHODS: A twenty-five question exam was completed by nurses and nurse technicians over a two-year period before and after mandatory CPR training with high-fidelity simulation. RESULTS: Most HCPs scored near 50% or below the passing score (80%) with a mean range of scores between 28% and 84%. HCPs missed questions on the exam that requested specific details related to technique or human physiology during CPR. CONCLUSION: The current teaching method for basic life support may be enhanced by using high-fidelity simulation, but this modality alone is not enough to support HCPs retention of CPR knowledge. Additional studies are needed to identify strategies that will help HCPs remember specific and detailed information in the CPR algorithm.


Asunto(s)
Reanimación Cardiopulmonar , Personal de Enfermería , Humanos , Encuestas y Cuestionarios
14.
J Cardiovasc Electrophysiol ; 26(1): 70-8, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25091691

RESUMEN

INTRODUCTION: We tested the hypothesis that subcutaneous nerve activity (SCNA) of the thorax correlates with the stellate ganglion nerve activity (SGNA) and can be used to estimate the sympathetic tone. METHODS AND RESULTS: We implanted radio transmitters in 11 ambulatory dogs to record left SGNA, left thoracic vagal nerve activity (VNA), and left thoracic SCNA, including 3 with simultaneous video monitoring and nerve recording. Two additional dogs were studied under general anesthesia with apamin injected into the right stellate ganglion while the right SGNA and the right SCNA were recorded. There was a significant positive correlation between integrated SGNA (iSGNA) and integrated SCNA (iSCNA) in the first 7 ambulatory dogs, with correlation coefficient of 0.70 (95% confidence interval [CI] 0.61-0.84, P < 0.05 for each dog). Tachycardia episodes (heart rate exceeding 150 bpm for ≥3 seconds) were invariably preceded by SGNA and SCNA. There was circadian variation of both SCNA and SGNA. Crosstalk was ruled out because SGNA, VNA, and SCNA bursts had different timing and activation patterns. In an eighth dog, closely spaced bipolar subcutaneous electrodes also recorded SCNA, but with reduced signal to noise ratio. Video monitoring in additional 3 dogs showed that movement was not a cause of high frequency SCNA. The right SGNA correlated strongly with right SCNA and heart rate in 2 anesthetized dogs after apamin injection into the right stellate ganglion. CONCLUSIONS: SCNA recorded by bipolar subcutaneous electrodes correlates with the SGNA and can be used to estimate the sympathetic tone.


Asunto(s)
Locomoción , Ganglio Estrellado/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Taquicardia/diagnóstico , Taquicardia/fisiopatología , Telemetría , Nervios Torácicos/fisiopatología , Animales , Biomarcadores/análisis , Ritmo Circadiano , Modelos Animales de Enfermedad , Perros , Frecuencia Cardíaca , Inmunohistoquímica , Valor Predictivo de las Pruebas , Procesamiento de Señales Asistido por Computador , Sistema Nervioso Simpático/enzimología , Taquicardia/enzimología , Telemetría/instrumentación , Nervios Torácicos/enzimología , Factores de Tiempo , Tirosina 3-Monooxigenasa/análisis , Nervio Vago/fisiopatología , Grabación en Video
15.
J Contin Educ Nurs ; 46(1): 34-40, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25406636

RESUMEN

Applied knowledge was observed among nurse groups from a medical-surgical residency program to measure clinical performance during simulation training. Twenty groups of new graduate nurses were observed during five simulated clinical scenarios, and their performances were scored on a 24-item checklist. Nurse groups showed significant improvement (p < 0.001) in applied knowledge in four clinical domains from week 1 to week 5, and the results provided valuable information of the groups' overall performances. In two of the five scenarios, poor decisions and prioritization of competing tasks were factors associated with lower performance group scores. Complex patient conditions may pose a challenge for new graduate nurses, and standardized training during the residency program may help instructors recognize specific factors to address during the transition from education to practice.


Asunto(s)
Competencia Clínica , Educación Continua en Enfermería/organización & administración , Lista de Verificación , Enfermedad Crónica/enfermería , Curriculum , Toma de Decisiones , Evaluación Educacional , Humanos , Personal de Enfermería en Hospital/educación , Estudios Retrospectivos
16.
Br J Clin Pharmacol ; 78(2): 244-57, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24313856

RESUMEN

Pre-eclampsia is a serious multisystem disorder with diverse clinical manifestations. Although not causal, endothelial dysfunction and reduced nitric oxide bioavailability are likely to play an important role in the maternal and fetal pathophysiology of this condition. Lack of treatment modalities that can target the underlying pathophysiological changes and reverse the endothelial dysfunction frequently leads to iatrogenic preterm delivery of the fetus, causing neonatal morbidity and mortality, and the condition itself is associated with short- and longer term maternal morbidity and mortality. Drugs that target various components of the nitric oxide-soluble guanylyl cyclase pathway can help to increase NO bioavailability. The purpose of this review is to outline the current status of clinical research involving these therapeutic modalities in the context of pre-eclampsia, with the focus being on the following: nitric oxide donors, including organic nitrates and S-nitrosothiols; l-arginine, the endogenous precursor of NO; inhibitors of cyclic guanosine 3',5'-monophosphate breakdown, including sildenafil; and other novel inhibitors of NO donor metabolism. The advantages and limitations of each modality are outlined, and scope for development into established therapeutic options for pre-eclampsia is explored.


Asunto(s)
Endotelio Vascular/metabolismo , Donantes de Óxido Nítrico/uso terapéutico , Óxido Nítrico/metabolismo , Inhibidores de Fosfodiesterasa/uso terapéutico , Preeclampsia/metabolismo , Preeclampsia/prevención & control , Aldehído Oxidorreductasas/antagonistas & inhibidores , Ensayos Clínicos como Asunto , Endotelio Vascular/efectos de los fármacos , Femenino , Humanos , Dinitrato de Isosorbide/administración & dosificación , Dinitrato de Isosorbide/uso terapéutico , Donantes de Óxido Nítrico/administración & dosificación , Nitroglicerina/administración & dosificación , Nitroglicerina/uso terapéutico , Inhibidores de Fosfodiesterasa/administración & dosificación , Piperazinas/administración & dosificación , Piperazinas/uso terapéutico , Preeclampsia/enzimología , Preeclampsia/etiología , Embarazo , Purinas/administración & dosificación , Purinas/uso terapéutico , S-Nitrosotioles/administración & dosificación , S-Nitrosotioles/uso terapéutico , Citrato de Sildenafil , Sulfonamidas/administración & dosificación , Sulfonamidas/uso terapéutico
17.
Br J Clin Pharmacol ; 78(3): 660-9, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24627995

RESUMEN

AIMS: To determine the effects of in vivo S-nitrosoglutathione (GSNO) infusion on cardiovascular function, platelet function, proteinuria and biomarker parameters in early-onset pre-eclampsia. METHODS: We performed an open-label dose-ranging study of GSNO in early-onset pre-eclampsia. Six women underwent GSNO infusion whilst receiving standard therapy. The dose of GSNO was increased incrementally to 100 µg min(-1) whilst maintaining blood pressure of >140/80 mmHg. Aortic augmentation index, aortic pulse wave velocity, blood pressure and maternal-fetal Doppler parameters were measured at each dose. Platelet P-selectin, protein-to-creatinine ratio and soluble anti-angiogenic factors were measured pre- and postinfusion. RESULTS: Augmentation index fell at 30 µg min(-1) S-nitrosoglutathione (-6%, 95% confidence interval 0.6 to 13%), a dose that did not affect blood pressure. Platelet P-selectin expression was reduced [mean (interquartile range), 6.3 (4.9-7.6) vs. 4.1 (3.1-5.7)% positive, P = 0.03]. Soluble endoglin levels showed borderline reduction (P = 0.06). There was a borderline significant change in pre-to-postinfusion protein-to-creatinine ratio [mean (interquartile range), 0.37 (0.09-0.82) vs. 0.23 (0.07-0.49) g mmol(-1) , P = 0.06]. Maternal uterine and fetal Doppler pulsatility indices were unchanged. CONCLUSIONS: In early-onset pre-eclampsia, GSNO reduces augmentation index, a biomarker of small vessel tone and pulse wave reflection, prior to affecting blood pressure. Proteinuria and platelet activation are improved at doses that affect blood pressure minimally. These effects of GSNO may be of therapeutic potential in pre-eclampsia, a condition for which no specific treatment exists. Clinical studies of GSNO in early-onset pre-eclampsia will determine whether these findings translate to improvement in maternal and/or fetal outcome.


Asunto(s)
Donantes de Óxido Nítrico/uso terapéutico , Preeclampsia/tratamiento farmacológico , Proteinuria/tratamiento farmacológico , S-Nitrosoglutatión/uso terapéutico , Adulto , Presión Sanguínea/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Donantes de Óxido Nítrico/administración & dosificación , Selectina-P/metabolismo , Activación Plaquetaria/efectos de los fármacos , Preeclampsia/fisiopatología , Embarazo , Análisis de la Onda del Pulso , S-Nitrosoglutatión/administración & dosificación , Ultrasonografía Prenatal/métodos , Adulto Joven
18.
Inorg Chem ; 53(19): 10045-53, 2014 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-25221909

RESUMEN

As a continuation of work on metallacarborane-based molecular motors, the structures of substituted bis(dicarbollyl)nickel complexes in Ni(III) and Ni(IV) oxidation states were investigated in solution by fluorescence spectroscopy. Symmetrically positioned cage-linked pyrene molecules served as fluorescent probes to enable the observation of mixed meso-trans/dl-gauche (pyrene monomer fluorescence) and dl-cis/dl-gauche (intramolecular pyrene excimer fluorescence with residual monomer fluorescence) cage conformations of the nickelacarboranes in the Ni(III) and Ni(IV) oxidation states, respectively. The absence of energetically disfavored conformers in solution--dl-cis in the case of nickel(III) complexes and meso-trans in the case of nickel(IV)--was demonstrated based on spectroscopic data and conformer energy calculations in solution. The conformational persistence observed in solution indicates that bis(dicarbollyl)nickel complexes may provide attractive templates for building electrically driven and/or photodriven molecular motors.


Asunto(s)
Boranos/química , Níquel/química , Compuestos Organometálicos/química , Estructura Molecular , Oxidación-Reducción , Soluciones , Espectrometría de Fluorescencia
19.
Sci Rep ; 14(1): 3439, 2024 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-38341453

RESUMEN

This paper presents an AI-powered solution for detecting and monitoring Autonomic Dysreflexia (AD) in individuals with spinal cord injuries. Current AD detection methods are limited, lacking non-invasive monitoring systems. We propose a model that combines skin nerve activity (SKNA) signals with a deep neural network (DNN) architecture to overcome this limitation. The DNN is trained on a meticulously curated dataset obtained through controlled colorectal distension, inducing AD events in rats with spinal cord surgery above the T6 level. The proposed system achieves an impressive average classification accuracy of 93.9% ± 2.5%, ensuring accurate AD identification with high precision (95.2% ± 2.1%). It demonstrates a balanced performance with an average F1 score of 94.4% ± 1.8%, indicating a harmonious balance between precision and recall. Additionally, the system exhibits a low average false-negative rate of 4.8% ± 1.6%, minimizing the misclassification of non-AD cases. The robustness and generalizability of the system are validated on unseen data, maintaining high accuracy, F1 score, and a low false-negative rate. This AI-powered solution represents a significant advancement in non-invasive, real-time AD monitoring, with the potential to improve patient outcomes and enhance AD management in individuals with spinal cord injuries. This research contributes a promising solution to the critical healthcare challenge of AD detection and monitoring.


Asunto(s)
Disreflexia Autónoma , Tejido Nervioso , Traumatismos de la Médula Espinal , Humanos , Ratas , Animales , Disreflexia Autónoma/diagnóstico , Disreflexia Autónoma/terapia , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/terapia , Inteligencia Artificial , Médula Espinal , Presión Sanguínea/fisiología
20.
J Psychopharmacol ; 38(2): 200-212, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38151883

RESUMEN

BACKGROUND: Neuronal primary cilia are being recognized for their role in mediating signaling associated with a variety of neurobehaviors, including responses to drugs of abuse. They function as signaling hubs, enriched with a diverse array of G-protein coupled receptors (GPCRs), including several associated with motivation and drug-related behaviors. However, our understanding of how cilia regulate neuronal function and behavior is still limited. AIMS: The objective of the current study was to investigate the contributions of primary cilia on specific neuronal populations to behavioral responses to cocaine. METHODS: To test the consequences of cilia loss on cocaine-induced locomotion and reward-related behavior, we selectively ablated cilia from dopaminergic or GAD2-GABAergic neurons in mice. RESULTS: Cilia ablation on either population of neurons failed to significantly alter acute locomotor responses to cocaine at a range of doses. With repeated administration, mice lacking cilia on GAD2-GABAergic neurons showed no difference in locomotor sensitization to cocaine compared to wild-type (WT) littermates, whereas mice lacking cilia on dopaminergic neurons exhibited reduced locomotor sensitization to cocaine at 10 and 30 mg/kg. Mice lacking cilia on GAD2-GABAergic neurons showed no difference in cocaine conditioned place preference (CPP), whereas mice lacking cilia on dopaminergic neurons exhibited reduced CPP compared to WT littermates. CONCLUSIONS: Combined with previous findings using amphetamine, our results show that behavioral effects of cilia ablation are cell- and drug type-specific, and that neuronal cilia contribute to modulation of both the locomotor-inducing and rewarding properties of cocaine.


Asunto(s)
Cocaína , Ratones , Animales , Cocaína/farmacología , Cilios , Neuronas Dopaminérgicas , Recompensa , Locomoción
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