Comparison between Invasive Intervention and Conservative Treatment in Patients with In-Hospital Myocardial Infarctions: Results from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA) Study.

Background/Objectives: In-hospital myocardial infarctions (AMIs) are less often treated with invasive intervention, compared to out-of-hospital AMIs. We aimed to identify the determinants of invasive intervention in patients with in-hospital AMIs and assess its association with mortality, compared to conservative treatment. Methods: This was a cross-sectional study of in-hospital AMIs in The Regional Myocardial Infarction Registry of Saxony-Anhalt. Patients' characteristics and outcomes were compared based on the treatment strategy (invasive intervention vs. conservative treatment). Logistic regression was performed to assess the determinants of invasive intervention (vs. conservative treatment) and its association with 30-day mortality. Results: Nearly 67% of the patients (259/386) received invasive intervention, and the rest were treated conservatively. Those who were treated with an invasive intervention were younger and had a lower proportion of chronic heart failure than those treated conservatively. Age > 75 years compared to younger patients, pre-existing heart failure, and higher heart rate upon presentation were associated with lower odds of receiving invasive intervention. Hypertension (OR = 2.86, 95% CI [1.45-5.62]) and STEMI vs. NSTEMI (1.96, [1.10-3.68]) were associated with higher odds of invasive intervention. The adjusted odds of 30-day mortality were lower with invasive intervention compared to conservative treatment (0.25, [0.10-0.67]). Conclusions: One-third of the patients with in-hospital AMIs received conservative treatment. Younger age, absence of heart failure, lower heart rate, hypertension, and STEMI were determinants of invasive intervention usage. Invasive intervention had lower odds of 30-day mortality, but longitudinal studies are still needed to assess the efficacy of conservative vs. invasive strategies in in-hospital AMIs.

Fitness for practice in nursing and midwifery education in Scotland, United Kingdom.

AIM: The aim of this paper is to report findings from a major study that evaluated the Fitness for Practice nursing and midwifery curriculum in Scotland, UK. BACKGROUND: The competence of student nurses and midwives at the point of registration has been the focus of debate and research. However, no major study, on such a large scale, had specifically evaluated pre-registration programmes to determine whether they enabled students to achieve 'fitness to practice'. DESIGN: The study had a broad evaluation design conducted in three phases using a mixed methodology. METHOD: Phase 1 involved questionnaires, Objective Structured Clinical Examination's (OSCE) and curriculum evaluation. Phase 2 involved semi-structured interviews (some telephone) and focus groups across main stakeholders: students (n = 78), mentors (n = 78), practice-education facilitators (n = 24), academics (n = 59), senior clinical (n = 46) and education managers (n = 16), service users and carers (n = 10). RESULTS: The findings suggest that the Fitness for Practice curriculum model in Scotland has on the whole been successful. The key finding is the predominant opinion of stakeholders that newly qualified nurses and midwives are perceived as being fit for practice at the point of registration. A perceived lack of confidence is, as with all transitions to new roles, an understandable outcome. CONCLUSIONS: Previous concern that student nurses and midwives are not 'fit for practice' has focused on the perceived lack of clinical skills at the point of registration, not on competence to practice in general. This study demonstrates that this is an important distinction and recognises that registration is only the beginning of a life long learning experience. RELEVANCE TO CLINICAL PRACTICE: Students need to be supported to develop their confidence following registration as well as additional skills in their chosen field of practice. Appropriate mentorship and a period of preceptorship should be in place to accommodate this.

An evaluation of fitness for practice curricula: self-efficacy, support and self-reported competence in preregistration student nurses and midwives.

AIMS AND OBJECTIVES: This element of the larger Scottish evaluation aimed to explore differences between access routes, cohorts and higher education institutes (HEI) (universities and colleges) in levels of self-efficacy, student support and self-reported competence in a nationally representative sample of student nurses and midwives. BACKGROUND: This paper reports findings from the National Review of Pre-Registration Nursing and Midwifery Programmes in Scotland. Fitness for practice curricula have been the heart of many recent developments in nurse and midwifery education. Fitness for practice set out to map out the future direction of preregistration nursing and midwifery education with the aim of ensuring fitness for practice based on healthcare need. There have been no national evaluations of the effectiveness of this strategic objective. Previous major evaluations in the 1990s suggested that students may not have had the skills needed to be fit for practice. DESIGN: The study design was a cross-sectional survey of a stratified random sample of student nurses and midwives (n = 777). Data collected included demographic information, generalised perceived self-efficacy, student support and self-reported competency. RESULTS: Students reported high levels of self-reported competency. There were no significant differences between two cohorts or between students with different access routes. Students rated support from family and friends highest and support from HEI lowest. There was a significant difference in support levels between HEI. Self-efficacy scores were similar to other population means and showed small-moderate correlations with self-report competence. Similarly, self-reported competency appears to be at the higher end of the spectrum, although older students may have a more realistic perception of their competence. However, support from HEI was seen as less satisfactory and varied from one institution to another. CONCLUSIONS: This study portrays a relatively positive picture of preregistration fitness for practice curricula. Questions are raised about the relative value students place on support from educationalists and mentors and whether support from family and friends and from peers needs to feature more prominently in curricula. The study provides modest support for social cognitive theory. RELEVANCE TO CLINICAL PRACTICE: The major drivers for changes in preregistration curricula stemmed from fears about the competence of students. This study did not provide support for this viewpoint, and students' self-reports suggest that curricula are, in this respect, meeting their objectives. Nevertheless support from mentors and from educational institutes may need to be improved.

A review of curriculum evaluation in United Kingdom nursing education.

Recently we have witnessed several significant changes to the nursing curriculum in the United Kingdom (UK). This review forms part of a larger study evaluating the 'fitness for practice' elements of the nursing curriculum in Scotland. Systematic review methods were used including the following databases: CINAHL and BNI. Twenty six papers were retrieved and 14 remained after applying the review criteria, the main rationale being the empirical focus. It appears that there is a paucity of research in this area in the UK and papers dealt exclusively with either content, process or outcome evaluation of the nursing curriculum. National, well funded, multi-centre studies tended to be more rigorous. Results, where they were positive about curricular changes, tended to be limited. There is clearly a need for rigorous research into curriculum evaluation, both at the micro and macro level, which investigates content, process and outcome. Without such research, curriculum change will be uninformed.

Measuring competence, self-reported competence and self-efficacy in pre-registration students.

AIM: To measure competence, self-reported competence and self-efficacy; explore any differences between cohorts and student entry criteria; and explore the relationship between competence, self-reported competence, support and self-efficacy. METHOD: All students undertook a three-station objective structured clinical examination (OSCE) and had previously completed a questionnaire, which included measures of self-reported competence, support and self-efficacy. The performance of two single year cohorts enabled measurement of competence development and progression. RESULTS: Students were competent in the core generalist skills of communication and hand decontamination but demonstrated low levels of numeracy. CONCLUSION: Doubts are raised about the explanatory value or practical use of social cognitive theory in pre-registration curricula and questions are raised about the value of self-reported competence. This has implications for nursing and midwifery curricula, which emphasise the importance of self-assessment.

Functional mapping and identification of novel regulators for the Toll/Interleukin-1 signalling network by transcription expression cloning.

Sustained inflammatory responses are central to the development and progression of chronic diseases, including atherosclerosis and rheumatoid arthritis. A large number of stimuli initiate inflammation by acting on Toll-Interleukin-1 related (TIR) domain containing receptors, producing multiple second messengers and thence large scale transcriptional changes. The mechanism by which this activation occurs is complex, and the continuing isolation of novel pathway components, mostly based on sequence similarities and protein-protein interaction studies, suggests that many elements of the TIR-initiated signalling network remain to be identified. Here we use a new technique, allowing identification of components based on function. We report the performance of the screen, our identification of human tribbles as a novel protein family regulating inflammatory signalling networks, and the detection of ten other components with poorly characterized roles in inflammatory signalling pathways. In total, we have identified 28 signalling molecules of diverse molecular mechanism by screening 11% of a cDNA library for the ability to modulation expression of human IL-8, and other molecules remain to be followed up. The results suggest that the number of human genes involved in IL-8 induction pathways exceed 100. The isolation of signalling components by the approach we describe allows detection of new classes of signalling components independent of existing techniques for doing so; it is simple and robust, and constitutes a general method for mapping signal transduction systems controlling gene expression.

Spiritual Intimacy, Marital Intimacy, and Physical/Psychological Well-Being: Spiritual Meaning as a Mediator.

OBJECTIVE: Intimacy is an essential part of marital relationships, spiritual relationships, and is also a factor in well-being, but there is little research simultaneously examining the links among spiritual intimacy, marital intimacy, and well-being. METHODS: Structural equation modeling was used to examine associations among the latent variables-spiritual intimacy, marital intimacy, spiritual meaning, and well-being-in a cross-sectional study of 5,720 married adults aged 29-100 years (M = 58.88, SD = 12.76, 59% female). All participants were from the Adventist Health Study-2, Biopsychosocial Religion and Health Study. RESULTS: In the original structural model, all direct associations between the three latent variables of spiritual intimacy, marital intimacy, and well-being were significantly positive indicating that there was a significant relationship among spiritual intimacy, marital intimacy, and well-being. When spiritual meaning was added as a mediating variable, the direct connections of spiritual intimacy to marital intimacy and to well-being became weakly negative. However, the indirect associations of spiritual intimacy with marital intimacy and with well-being were then strongly positive through spiritual meaning. This indicates that the relationship among spiritual intimacy, marital intimacy, and well-being was primarily a result of the meaning that spiritual intimacy brought to one's marriage and well-being, and that without spiritual meaning greater spirituality could negatively influence one's marriage and well-being. CONCLUSIONS: These findings suggest the central place of spiritual meaning in understanding the relationship of spiritual intimacy to marital intimacy and to well-being.

Evaluation of a New Zealand program to improve transition of care for older high risk adults.

Transition interventions aim to improve care and reduce hospital readmissions but evaluations of these interventions have reported inconsistent results. We report on the evaluation of an intervention implemented in Auckland, New Zealand. Participants were people over the age of 65 who had an acute medical admission and were at high risk of readmission. The intervention included an improved discharge process and nurse telephone follow-up soon after discharge. Outcomes were 28 day readmission rates and emergency attendances. The study is observational, using both interrupted times series and regression discontinuity designs. 5239 patients were treated over a one year period. There was no change in readmission rates or ED attendances or secondary outcomes. Not all patients received all components of the intervention. This transition intervention was not successful. Possible reasons for this and implications are discussed. Although non-experimental methods were used, we believe the results are robust.

Development of an X-ray pixel detector with multi-port charge-coupled device for X-ray free-electron laser experiments.

This paper presents development of an X-ray pixel detector with a multi-port charge-coupled device (MPCCD) for X-ray Free-Electron laser experiments. The fabrication process of the CCD was selected based on the X-ray radiation hardness against the estimated annual dose of 1.6 × 10(14) photon/mm(2). The sensor device was optimized by maximizing the full well capacity as high as 5 Me- within 50 µm square pixels while keeping the single photon detection capability for X-ray photons higher than 6 keV and a readout speed of 60 frames/s. The system development also included a detector system for the MPCCD sensor. This paper summarizes the performance, calibration methods, and operation status.

WITHDRAWN: Editorial Commentary.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/<10.1016/j.nepr.2012.09.001>. The duplicate article has therefore been withdrawn.

A review of evidence for the practice learning environment: enhancing the context for nursing and midwifery care in Scotland.

This paper considers the issues which will ensure practice learning excellence in the future and in particular how these will impact on the delivery of high quality nursing and midwifery care in Scotland in the United Kingdom (UK). This will include the inter-dependency of learning in practice for undergraduate pre-registration students and qualified practitioners, in particular continuing professional development as a lifelong experience and its link to quality care provision. We contend that the practice learning environment is the whole of an organisation which values and supports the development of its workforce through education. Partnership working between education and service providers is central to ensuring an educated and professionally prepared workforce. Both nursing and midwifery are practice-based professions which are accountable for, and charged with assuring, effective public health and safety. The initial paper which established the key issues discussed here was initially written as one of the key background papers for a consensus conference to inform NHS Education for Scotland's nursing and midwifery workforce development over the next five years (NES 2009).

Identification of 34 novel proinflammatory proteins in a genome-wide macrophage functional screen.

Signal transduction pathways activated by Toll-like Receptors and the IL-1 family of cytokines are fundamental to mounting an innate immune response and thus to clearing pathogens and promoting wound healing. Whilst mechanistic understanding of the regulation of innate signalling pathways has advanced considerably in recent years, there are still a number of critical controllers to be discovered. In order to characterise novel regulators of macrophage inflammation, we have carried out an extensive, cDNA-based forward genetic screen and identified 34 novel activators, based on their ability to induce the expression of cxcl2. Many are physiologically expressed in macrophages, although the majority of genes uncovered in our screen have not previously been linked to innate immunity. We show that expression of particular activators has profound but distinct impacts on LPS-induced inflammatory gene expression, including switch-type, amplifier and sensitiser behaviours. Furthermore, the novel genes identified here interact with the canonical inflammatory signalling network via specific mechanisms, as demonstrated by the use of dominant negative forms of IL1/TLR signalling mediators.

Enhanced macrophage tribbles-1 expression in murine experimental atherosclerosis.

Development of the atherosclerotic plaque involves a complex interplay between a number of cell types and an extensive inter-cellular communication via cell bound as well as soluble mediators. The family of tribbles proteins has recently been identified as novel controllers of pro-inflammatory signal transduction. The objective of this study was to address the expression pattern of all three tribbles proteins in atherosclerotic plaques from a mouse model of atherosclerosis. Each tribbles were expressed in vascular smooth muscle cells, endothelial cells as well as in resident macrophages of mouse atherosclerotic plaques. The role of IL-1 mediated inflammatory events in controlling tribbles expression was also addressed by inducing experimental atherosclerosis in ApoE-/-IL1R1-/- (double knockout) mice. Immunohistochemical analysis of these mice showed a selective decrease in the percentage of trb-1 expressing macrophages, compared to the ApoE-/- cohort (14.7% ± 1.55 vs. 26.3% ± 1.19). The biological significance of this finding was verified in vitro where overexpression of trb-1 in macrophages led to a significant attenuation (~70%) of IL-6 production as well as a suppressed IL-12 expression induced by a proinflammatory stimulus. In this in vitro setting, expression of truncated trb-1 mutants suggests that the kinase domain of this protein is sufficient to exert this inhibitory action.

Early findings from an evaluation of a post-registration staff development programme: The Flying Start NHS initiative in Scotland, UK.

The first year post-qualifying as a nurse or midwife is often seen as a key transitional period. Flying Start NHS is the national development programme for all newly qualified nurses, midwives and allied health professionals in NHS Scotland. It is designed to support the transition from student to newly qualified health professional through supporting learning in everyday practice. It is a web-based or CD-ROM programme which seeks to increase the confidence and competence of newly qualified nurses and midwives during their first year of employment following registration. The aims of this study were to establish levels of self-report competency, self-efficacy, job demands and career intentions in newly qualified nurses undertaking Flying Start NHS programme in Scotland. The aims were met by conducting a cross-sectional survey of Flying Start NHS students. Newly qualified nurse participants (n=97) comprised a convenience sample of newly qualified nurses who were registered as undertaking the Flying Start NHS on-line programme during Autumn-Winter 2007. Most newly qualified nurses intend to remain in the NHS although a small but important number may leave.