Association of Depression Onset and Treatment With Blood Pressure Control After Intracerebral Hemorrhage.

BACKGROUND: Blood pressure (BP) control represents a crucial intervention to improve long-term outcomes following spontaneous intracerebral hemorrhage (ICH). However, fewer than half of ICH survivors achieve target treatment goals. ICH survivors are also at very high risk for poststroke depression, which may contribute to inadequate BP control. We, therefore, sought to determine whether depressive symptoms after ICH are associated with inadequate BP control. We also investigated whether associations between depression after ICH and BP measurements were mediated by treatment with selective serotonin reuptake inhibitors or norepinephrine-serotonin reuptake inhibitors antidepressants. METHODS: We leveraged data from a single-center longitudinal study of ICH conducted at Massachusetts General Hospital (Boston, MA) between 2006 and 2018. We collected data from semiautomated review of electronic health records, baseline and follow-up interviews, and computed tomography imaging. Information on BP measurements, depression diagnoses, antidepressants medication use, and medical visits were collected longitudinally and analyzed using mixed effects models. Primary outcomes included systolic and diastolic BP measurements during long-term follow-up after ICH. RESULTS: We included 1243 consecutive ICH patients without pre-stroke depression history. Of these, 721 (58%) were diagnosed with incident depression over a median follow-up time of 52.8 months (interquartile range, 42.1-60.5). Depression onset was associated with subsequent increase in systolic (+8.3 mm Hg, SE, 2.4 mm Hg, P=0.012) and diastolic (+4.4 mm Hg, SE, 1.2 mm Hg) BP measurements. Resolution of depressive symptoms was associated with subsequent decrease in systolic (-5.9 mm Hg, SE, 1.4 mm Hg, P=0.031) and diastolic (-3.4 mm Hg, SE, 1.1 mm Hg, P=0.041) BP measurements. We also found associations between higher systolic BP measurements and use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants, independent of whether depression symptoms were active or not (all P<0.05). CONCLUSIONS: ICH survivors displayed increasing BP values after receiving a diagnosis of depression, followed by decreasing values among those experiencing resolution of depressive symptoms. Use of selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor antidepressants was independently associated with higher systolic BP measurements. Clinicians ought to closely monitor BP for ICH survivors being treated for depression, especially using selective serotonin reuptake inhibitor and noradrenaline-serotonin reuptake inhibitor. Future studies will also be required to investigate the mechanisms underlying these associations.

Developing and characterizing a two-layered safety switch for cell therapies.

Gene edited and engineered cell-based therapies are a promising approach for treating a variety of disorders, including cancer. However, the ability of engineered cells to persist for prolonged periods along with possible toxicity raises concerns over the safety of these approaches. Although a number of different one-dimensional suicide systems have been incorporated into therapeutic cell types, the incorporation of a two-layered suicide system that allows controlled killing of therapeutic cells at different time points is needed. In this study, we engineered a variety of therapeutic cells to express two different kill switches, RapaCasp9 and HSV-TK and utilized Rapamycin and Ganciclovir respectively to activate these kill switches. We show that the function of both RapaCasp9 and HSV-TK molecules is preserved and can be activated to induce apoptosis detected early (24 h) and late (48 h) post-activation respectively, with no toxicity. In vivo, we show the eradication of a majority of cells after treatment in subcutaneous and orthotopic models. Furthermore, we demonstrate how both suicide switches work independently and can be activated sequentially for an improved killing, thus ensuring a failsafe mechanism in case the activation of a single one of them is not sufficient to eliminate the cells. Our findings highlight the reliability of the double suicide system, effective on a variety of cells with different biological characteristics, independent of their anatomic presence.

Transitional Experiences: From Clinical Nurse to Nurse Faculty.

BACKGROUND: A limited pool of nurse faculty has affected enrollment of nursing students and the ability to produce the nursing workforce needed for the evolving health care system. The experiences clinical nurses face as they transition to the faculty role may contribute to the faculty shortage. METHOD: A qualitative descriptive study was conducted to explore the lived experiences of clinical nurses as they entered the nurse faculty role. A purposive sample was recruited from two higher learning institutions in the midwestern United States. Data analysis was performed using Colaizzi's method. RESULTS: Four themes emerged: Perpetual Novice, Faculty as a Resource, Teaching Ambiguity, and Student as My Patient. The prominent theme surrounded the idea that the faculty were in a state of constant change as a perpetual novice. CONCLUSION: Implications exist for academic nursing program administration to invest in developing nurse faculty skill level and ease the transition to the role. [J Nurs Educ. 2019;58(5):260-265.].

Planning, surveillance, and reporting for pandemic influenza: a briefing for advanced practice nurses.

PURPOSE: To provide advanced practice nurses (APNs) with information necessary to participate in pandemic influenza planning and response. Key epidemiological terms and pandemic alert designations are reviewed. Influenza surveillance activities at the local, state, and national levels are summarized. Responsibilities of the APN are discussed, and resources are provided. DATA SOURCES: Review of the published literature, epidemiology text books, U.S. Department of Health and Human Services (USDHHS) Pandemic Influenza Plan, state pandemic influenza plans, U.S. Centers for Disease Control and Prevention, World Health Organization, and USDHHS Internet resources. CONCLUSIONS: Recent public health emergencies have brought to light the need for APNs to become educated regarding emergency planning and response. APNs should be familiar with terminology, current activities, and potential responsibilities. IMPLICATIONS FOR PRACTICE: Resources presented in this article will help prepare APNs to participate in planning and response activities for pandemic influenza.

Tracking pediatric asthma: the Massachusetts experience using school health records.

The Massachusetts Department of Public Health, in collaboration with the U.S. Centers for Disease Control and Prevention Environmental Public Health Tracking Program, initiated a 3-year statewide project for the routine surveillance of asthma in children using school health records as the primary data source. School district nurse leaders received electronic data reporting forms requesting the number of children with asthma by grade and gender for schools serving grades kindergarten (K) through 8. Verification efforts from an earlier community-level study comparing a select number of school health records with primary care provider records demonstrated a high level of agreement (i.e., > 95%). First-year surveillance targeted approximately one-half (n = 958 schools) of all Massachusetts's K-8 schools. About 78% of targeted school districts participated, and 70% of the targeted schools submitted complete asthma data. School nurse-reported asthma prevalence was as high as 30.8% for schools, with a mean of 9.2%. School-based asthma surveillance has been demonstrated to be a reliable and cost-effective method of tracking disease through use of an existing and enhanced reporting structure.