Primary Stroke Center education for nurses: improving core measures.

Primary Stroke Center designation by the Joint Commission distinguishes those healthcare organizations with exemplary stroke prevention and management. However, meeting the Joint Commission's high-level excellence standards is challenging. This article provides nurse leaders with a stroke education template, based on Donabedian's quality model, which meets Primary Stroke Center nurse education requirements. The authors describe the structure, process, and outcomes of a stroke education program for nurses, recognized as Best-in-Practice in Connecticut, successfully implemented in a community hospital.

Association Between Provider Engagement, Staff Engagement, and Culture of Safety.

As healthcare organizations seek to improve patient experience, quality, and safety, employee engagement and perceptions of patient safety (POPS) have increasingly become foci of attention. Yet, the relationship between these constructs is poorly understood. We examined the correlation between provider and staff engagement (collectively, "employee engagement"), and between employee engagement and POPS in ambulatory and hospital environments. We found significant correlations between staff engagement and POPS, and between provider engagement and POPS in ambulatory and hospital environments. We also found significant correlation between provider and staff engagement. Although all correlations were weak (correlation coefficients of 0.17-0.47), there were significant increases in POPS with increases in employee engagement (in both ambulatory and hospital environments) and increases in provider engagement with increases in staff engagement. These increases range from 4% to 11% for every 17% increase in staff engagement. These findings suggest that healthcare systems seeking to improve provider engagement, staff engagement, and POPS may find synergistic effects between these efforts in ambulatory and hospital settings.

Lentiviral vector transduction of a dominant-negative Rev gene into human CD34+ hematopoietic progenitor cells potently inhibits human immunodeficiency virus-1 replication.

Gene therapy for human immunodeficiency virus (HIV)-1 may be performed by introducing into hematopoietic stem cells genes that inhibit replication of HIV-1 using lentiviral vectors. However, production of lentiviral vectors derived from HIV-1 may be inhibited by the gene being carried to inhibit HIV-1 and these vectors could be mobilized by wild-type HIV-1 infecting transduced cells. This study investigates these problems for the delivery of a dominant-negative rev gene humanized revM10 (huM10) by a lentiviral vector. Although most packaging plasmids suffered inhibition of expression of HIV-1 virion proteins by vectors expressing huM10, the packaging plasmids that expressed the highest levels of HIV-1 virion proteins produced vectors at titers that would be sufficient for clinical applications. The vectors carrying huM10 were used to transduce primary human CD34(+) hematopoietic progenitor cells and yielded high-level transduction without toxicity and conferred potent inhibition of HIV-1. The use of lentiviral vectors with deletion of the enhancers and promoter from the LTR (self-inactivating (SIN) vectors) decreased the frequency of vector mobilization by wild-type HIV-1; SIN vectors carrying huM10 were not mobilized detectably. These studies indicate that lentiviral vectors can be made effective for use in gene therapy for HIV-1.

University students' notebook computer use.

Recent evidence suggests that university students are self-reporting experiencing musculoskeletal discomfort with computer use similar to levels reported by adult workers. The objective of this study was to determine how university students use notebook computers and to determine what ergonomic strategies might be effective in reducing self-reported musculoskeletal discomfort in this population. Two hundred and eighty-nine university students randomly assigned to one of three towers by the university's Office of Housing participated in this study. The results of this investigation showed a significant reduction in self-reported notebook computer-related discomfort from pre- and post-survey in participants who received notebook computer accessories and in those who received accessories and participatory ergonomics training. A significant increase in post-survey rest breaks was seen. There was a significant correlation between self-reported computer usage and the amount measured using computer usage software (odometer). More research is needed however to determine the most effective ergonomics intervention for university students.

Screening for Pompe disease using a rapid dried blood spot method: experience of a clinical diagnostic laboratory.

Pompe disease (acid maltase deficiency; glycogen storage disease type II) is caused by deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA). Our clinical laboratory began to offer a fluorometric dried blood spot (DBS)-based GAA activity assay for Pompe disease in 2006 after the FDA approved GAA enzyme replacement therapy in April of that year. The purpose of this study was to examine the experience of our clinical laboratory in using this assay. Over a 2-year period, we received samples for the DBS GAA assay from 891 patients referred for possible Pompe disease, of whom 111 (12.5%) patients across the disease spectrum who had results in the affected range. The majority of the patients were referred by neurologists and geneticists. When available, we correlated the results obtained through DBS GAA activity assay with the results from a second DBS, or a second tissue (cultured skin fibroblasts or muscle biopsy). In our experience, the DBS GAA activity assay provides a robust, rapid, and reliable first tier test for screening patients suspected of having Pompe disease.

Dynamic tracking of human hematopoietic stem cell engraftment using in vivo bioluminescence imaging.

The standard approach to assess hematopoietic stem cell (HSC) engraftment in experimental bone marrow transplantation models relies on detection of donor hematopoietic cells in host bone marrow following death; this approach provides data from only a single time point after transplantation for each animal. In vivo bioluminescence imaging was therefore explored as a method to gain a dynamic, longitudinal profile of human HSC engraftment in a living xenogeneic model. Luciferase expression using a lentiviral vector allowed detection of distinctly different patterns of engraftment kinetics from human CD34+ and CD34+CD38- populations in the marrow NOD/SCID/beta 2mnull mice. Imaging showed an early peak (day 13) of engraftment from CD34+ cells followed by a rapid decline in signal. Engraftment from the more primitive CD34+CD38- population was relatively delayed but by day 36 increased to significantly higher levels than those from CD34+ cells (P <.05). Signal intensity from CD34+CD38-engrafted mice continued to increase during more than 100 days of analysis. Flow cytometry analysis of bone marrow from mice after death demonstrated that levels of 1% donor cell engraftment could be readily detected by bioluminescence imaging; higher engraftment levels corresponded to higher image signal intensity. In vivo bioluminescence imaging provides a novel method to track the dynamics of engraftment of human HSC and progenitors in vivo.