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1.
J Adv Nurs ; 2024 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-38294093

RESUMEN

AIM: To develop a framework for understanding the stress appraisal process among acute care nurses during the COVID-19 pandemic. DESIGN: A secondary analysis of open-ended responses from a cross-sectional survey of 3030 frontline, acute care nurses in New Jersey and the effect of burnout during the COVID-19 pandemic. METHODS: Lazarus and Folkman's transactional model of stress and coping guided the study. Thematic analysis was used to analyse 1607 open-ended responses. RESULTS: Nine themes emerged during the secondary appraisal of stress. Five themes contributed to distress and burnout including (1) high patient acuity with scarce resources, (2) constantly changing policies with inconsistent messaging, (3) insufficient PPE, (4) unprepared pandemic planning and (5) feeling undervalued. Four themes led to eustress and contributed to post-traumatic growth including (1) team nursing to ensure sufficient resource allocation, (2) open channels of communication, (3) sense- of-duty and (4) personal strength from new possibilities. CONCLUSION: The COVID-19 pandemic was a traumatic event for patients and the nursing workforce. Internal and external demands placed on acute care nurses increased burnout, however, a subset of nurses with adequate support experienced personal growth. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Beyond mental health interventions for acute care nurses, organizational interventions such as reevaluation of emergency action plans to optimize resource allocation, and work environment strategies such as improved communication and decision-making transparency are necessary. IMPACT: To better understand how frontline acute care nurses experienced stress during COVID-19, a data-informed framework was developed that included a primary and secondary appraisal of stress. Themes contributing to distress and burnout were identified, and themes leading to eustress and post-traumatic growth were also identified. These findings can assist nurse leaders in optimizing strategies to reduce burnout and promote post-traumatic growth in the post-COVID years. REPORTING METHOD: No patient or public contribution.

2.
Res Nurs Health ; 2024 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-38940259

RESUMEN

To examine the association between demographic characteristics (i.e., gender, race, age, and years of experience), burnout, and nurses' intent to leave their jobs during the first wave of COVID-19 in New Jersey. COVID-19 has exacerbated burnout and intent to leave among acute care nurses. Nonetheless, little is known about demographic factors contributing to nurses' desire to leave their jobs. A cross-sectional survey of actively licensed registered nurses who provided direct patient care in an acute care hospital in New Jersey during COVID-19. Among 2760 nurses, those who reported burnout were 4.78 times more likely to report intent to leave their job within 1 year as compared to nurses who did not report burnout. Black RNs were 2.06 times more likely to report intent to leave as compared to White RNs. Older nurses (aged 40-49) were 36% less likely to report intent to leave as compared to younger nurses (aged 21-29). RNs with 30 years of experience or more were 58% less likely to report intent to leave as compared to RNs with less than 5 years of experience. In addition, Black RNs with 6-12 years of experience were 2.07 times more likely to report intent to leave as compared to White RNs with less than 5 years of experience. Nurses' intent to leave during the first wave of the pandemic was influenced by burnout, race, age, and years of experience. Based on the results of the current study, Black nurses were more likely to report intent to leave their job within 1 year as compared to White RNs. Nurses' intention to leave is one of the most important global issues facing the healthcare system. Findings of the current study demonstrate that burnout, race, age, and years of experience are significant predictors of nurses' intent to leave their jobs. Therefore, organizations should prioritize strategies to reduce burnout and create diverse and inclusive work environments.

3.
Cancer ; 129(10): 1537-1546, 2023 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-36882377

RESUMEN

BACKGROUND: The nucleoside FF-10502-01, structurally similar to but with different biologic effects than gemcitabine, shows promising activity both alone and combined with cisplatin in preclinical gemcitabine-resistant tumor models. We conducted an open-label, single-arm, 3 + 3 first-in-human trial to explore the safety, tolerability, and antitumor activity of FF-10502-01 in patients with solid tumors. METHODS: Patients with inoperable metastatic tumors refractory to standard therapies were enrolled. Escalating intravenous FF-10502-01 doses (8-135 mg/m2 ) were administered weekly for 3 weeks in 28-day cycles until progressive disease or unacceptable toxicity was observed. Three expansion cohorts were subsequently evaluated. RESULTS: A phase 2 dose of 90 mg/m2 was determined after evaluating 40 patients. Dose-limiting toxicities included hypotension and nausea. Phase 2a enrolled patients with cholangiocarcinoma (36), gallbladder cancer (10), and pancreatic/other tumors (20). Common adverse events were grade 1-2 rash, pruritus, fever, and fatigue. Grade 3 or 4 hematologic toxicities were observed at low incidences, including thrombocytopenia (5.1%) and neutropenia (2%). Confirmed partial responses (PRs) occurred in five patients with gemcitabine-refractory tumors, including three with cholangiocarcinoma and one each with gallbladder and urothelial cancer. Median progression-free and overall survival rates in patients with cholangiocarcinoma were 24.7 and 39.1 weeks, respectively. Prolonged progression-free survival in patients with cholangiocarcinoma was associated with BAP1 and PBRM1 mutations. CONCLUSION: FF-10502-01 was well tolerated with manageable side effects and limited hematologic toxicity. Durable PRs and disease stabilizations were observed in heavily pretreated biliary tract patients who had received prior gemcitabine. FF-10502-01 is distinct from gemcitabine and may represent an effective therapy.


Asunto(s)
Neoplasias de los Conductos Biliares , Colangiocarcinoma , Neoplasias de la Vesícula Biliar , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Conductos Biliares Intrahepáticos , Colangiocarcinoma/tratamiento farmacológico , Desoxicitidina , Gemcitabina
4.
J Nurs Adm ; 52(7-8): 419-426, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35857913

RESUMEN

OBJECTIVE: The aim of this study was to examine the self-reported perceptions of the healthy work environment (HWE) of nurses who are members of Nursing Workplace Environment and Staffing Councils (NWESCs). BACKGROUND: In a statewide initiative, NWESCs were established at hospitals throughout the state of New Jersey as an alternative to nurse staffing ratio laws and to provide clinical nurses a voice in determining resources needed for patient care and support an HWE. METHODS: This quantitative descriptive study presents the results of the Healthy Workplace Environment Assessment Tool (HWEAT) and open-ended questions about NWESCs among a sample of 352 nurses. RESULTS: Three years after NWESC implementation, all HWEAT standard mean scores increased and were rated higher than the American Association of Critical-Care Nurses benchmark. There were statistically significant differences in clinical nurses' perceptions of an HWE compared with nurse leaders. Respondents also shared their NWESC's best practices and challenges. Responses to questions identified NWESC best practices and challenges. CONCLUSION: This study offers insight into the improvement in nurses' perceptions of the HWE after the introduction of a statewide NWESCs. Structures such as the NWESCs may provide an alternative to mandated staffing ratios.


Asunto(s)
Personal de Enfermería en Hospital , Personal de Enfermería , Hospitales , Humanos , New Jersey , Admisión y Programación de Personal , Recursos Humanos , Lugar de Trabajo
5.
J Nurs Manag ; 30(6): 1913-1921, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-35478365

RESUMEN

AIM: The aim of this work is to examine staffing, personal protective equipment (PPE) adequacy and physical exhaustion that contributed to burnout and intent to leave among hospital nurses during the first peak of the COVID-19 pandemic. BACKGROUND: Burnout is associated with adverse nurse and patient outcomes. Identifying the magnitude of burnout that occurred during the pandemic can prepare managers for the long-term mental health effects on nurses. METHODS: A cross-sectional, electronic survey was administered to examine perceptions of burnout and intent to leave among all New Jersey hospital nurses from October 6 to October 26, 2020. RESULTS: A total of 3030 nurses responded with 64.3% reporting burnout and 36.5% reporting intent to leave the hospital within a year. There was a significant association between high levels of burnout and intent to leave (χ2  = 329.4; p = .001). There was no association between staffing and burnout; however, reporting inadequate PPE (OR = 1.77 [95% CI: 1.34-2.34]) and physical exhaustion (OR = 3.89 [95% CI: 3.19-4.76]) remained predictors of burnout among nurses. CONCLUSION: Inadequate PPE and physical exhaustion coupled with short staffing contributed to burnout and intent to leave. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should continue to utilize evidence-based mental health interventions and advocate within their nursing professional organizations for relief funds to reduce burnout.


Asunto(s)
Agotamiento Profesional , COVID-19 , Enfermeras y Enfermeros , Personal de Enfermería en Hospital , Agotamiento Profesional/complicaciones , Agotamiento Profesional/etiología , COVID-19/epidemiología , Estudios Transversales , Fatiga/complicaciones , Hospitales , Humanos , Satisfacción en el Trabajo , New Jersey/epidemiología , Personal de Enfermería en Hospital/psicología , Pandemias , Encuestas y Cuestionarios , Lugar de Trabajo/psicología
6.
J Cardiovasc Nurs ; 34(2): 115-123, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30211816

RESUMEN

BACKGROUND: Percutaneous coronary intervention (PCI) is recognized by both the American Heart Association and the American College of Cardiology as an optimal therapy to treat patients experiencing acute myocardial infarction (AMI) with ST-segment elevation myocardial infarction. A health policy aimed at improving outcomes for the patient with AMI is public reporting of whether a patient received a PCI. OBJECTIVE: A systematic review was conducted to evaluate the effect of public reporting for patients with AMI, specifically for those patients who receive PCI. METHODS: EMBASE, MEDLINE, Academic Search Premier, Google Scholar, and PubMed were searched from inception through August 2017. Articles were selected for inclusion if researchers evaluated public reporting and included an outcome for whether a patient received a PCI during hospitalization for an AMI. Methodological quality of the included studies was evaluated, and findings were synthesized. RESULTS: Eight studies of high methodological quality were included in the review. Most studies found that, in areas of public reporting, patients were less likely to undergo a PCI and high-risk patients did not undergo a PCI. Researchers also found that patients with AMI had lower in-hospital mortality after the implementation of public reporting, but only if these patients received a PCI. CONCLUSIONS: Although public reporting may have had intentions of improving care, there is strong evidence that this policy did not result in more timely PCIs or improved mortality of patients with AMI. In fact, public reporting resulted in unintended consequences of not providing care for the most vulnerable patients in fear of an adverse outcome.


Asunto(s)
Infarto del Miocardio/cirugía , Intervención Coronaria Percutánea , Reportes Públicos de Datos en Atención de Salud , Humanos , Resultado del Tratamiento
7.
Nurs Res ; 66(1): 20-27, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-27977565

RESUMEN

BACKGROUND: Patients admitted to acute care hospitals on weekends have poorer outcomes than those admitted on weekdays, and patients admitted to hospitals for acute myocardial infarction (AMI) on weekends have a higher mortality rate than those admitted during the week. Very few studies have examined weekend presentation for patients with AMI with respect to mortality in the emergency department (ED). OBJECTIVE: The purpose of this research was to determine if weekend and holiday presentation is associated with increased mortality in EDs among patients with AMI in New Jersey. METHODS: A retrospective cohort and three data sources representing all hospitals in New Jersey, including patients 18-90 years of age who presented to the ED with symptoms of AMI from January 1, 2008 to January 31, 2010, were used. "Weekend" was defined as Saturday and Sunday, and "holiday" was defined as one of the six major U.S. holidays. Propensity score matching with probit regression was used to estimate the unbiased treatment effect of weekend/holiday presentation on mortality in the ED. RESULTS: A total of 1,343 patients with a diagnosis of AMI presented to 73 EDs in New Jersey. Of these, 382 (28%) presented on a weekend/holiday and 961 (72%) during weekday hours. After propensity score matching and using probit regression, weekend/holiday presentation was significantly associated with mortality (b = 0.30, 95% CI [0.03, 0.57]). Other statistically significant covariates include patient age (b = 0.03, 95% CI [0.02, 0.04], hospital technology status (b = 0.75, 95% CI [0.20, 1.30]), and nurse staffing (b = -0.08, 95% CI [-0.13, -0.04]). DISCUSSION: Weekend/holiday presentation to the ED for AMI was associated with increased mortality. The effect may be related to the limited availability of resources on weekend/holidays compared to weekdays. Future studies should examine potential variations of resources, nursing workload, and education and expertise of healthcare providers in the ED during the weekend.


Asunto(s)
Servicio de Urgencia en Hospital , Vacaciones y Feriados , Mortalidad Hospitalaria/tendencias , Infarto del Miocardio/mortalidad , Admisión del Paciente/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , New Jersey , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
8.
Nurs Adm Q ; 41(1): 48-55, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-27918404

RESUMEN

There is an unprecedented opportunity to move advanced practice nurses (APNs) into primary care settings at a steady rate over the next 5 to 8 years. In addition, the opportunity for nurse-owned or nurse-led practices has never been greater. However, many APNs currently work in a structured environment where the employer focuses on the business aspects of the practice and the APN focuses primarily on clinical care. Often APNs are unaware of the entrepreneurial contribution they make to the practice. A Needs Assessment Survey was developed to better understand business and practice management knowledge and skills of APNs in New Jersey. The survey included 14 categories for competency development. Twelve of the 14 categories showed that APNs were at a novice or an advanced beginner level. APNs need to demonstrate their value and take a lead to help solve primary care access issues. This can only be accomplished if APNs are willing to seize the opportunity and overcome barriers and knowledge gaps through both formal and informal education to step out of their traditional positions into more independent roles.


Asunto(s)
Enfermería de Práctica Avanzada/normas , Emprendimiento/tendencias , Humanos , New Jersey , Enfermeras Practicantes/psicología , Enfermeras Practicantes/normas , Enfermeras Practicantes/tendencias , Encuestas y Cuestionarios
9.
J Nurs Manag ; 24(2): 211-8, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25846993

RESUMEN

AIMS: To examine the conflict management style that emergency department (ED) nurses use to resolve conflict and to determine whether their style of managing conflict and a supportive work environment affects their experience of work stress. BACKGROUND: Conflict is a common stressor that is encountered as nurses strive to achieve patient satisfaction goals while delivering quality care. How a nurse perceives support may impact work stress levels and how they deal with conflict. METHODS: A correlational design examined the relationship between supportive work environment, and conflict management style and work stress in a sample of 222 ED nurses using the expanded nurse work stress scale; the survey of perceived organisational support; and the Rahim organisational conflict inventory-II. RESULTS: Twenty seven percent of nurses reported elevated levels of work stress. A supportive work environment and avoidant conflict management style were significant predictors of work stress. CONCLUSIONS: Findings suggest that ED nurses' perception of a supportive work environment and their approach to resolving conflict may be related to their experience of work stress. IMPLICATIONS FOR NURSING MANAGEMENT: Providing opportunities for ED nurses in skills training in constructive conflict resolution may help to reduce work stress and to improve the quality of patient care.


Asunto(s)
Conflicto Psicológico , Enfermería de Urgencia/organización & administración , Negociación/métodos , Enfermeras Especialistas/psicología , Personal de Enfermería en Hospital/psicología , Cultura Organizacional , Estrés Psicológico/etiología , Adolescente , Adulto , Femenino , Humanos , Satisfacción en el Trabajo , Modelos Lineales , Masculino , Persona de Mediana Edad , Negociación/psicología , Enfermeras Especialistas/organización & administración , Personal de Enfermería en Hospital/organización & administración , Autoinforme , Apoyo Social , Estrés Psicológico/prevención & control , Estados Unidos , Adulto Joven
10.
J Emerg Nurs ; 42(5): 395-9, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26972370

RESUMEN

PROBLEM: A 7.2% increase in patient volume from 130,700 to 140,800 in 2012 prompted St Joseph's Regional Medical Center Emergency Department to review existing triage processes to decrease turnaround time. "Pivot triage" is a new, efficient intake process that entails use of 4 rather than 8 determinants to identify acuity levels. The purpose of this performance improvement project was to create alternatives to traditional triage to decrease ED length of stay and door-to-physician time. METHODS: After education, the pivot process was implemented using 4 determinants established by a multidisciplinary team. The pivot process was slowly implemented for 6 hours over a 1-week period to work out processing issues. Arrival time, door-to-physician time, and departure time from the emergency department were elements used to calculate the patient's turnaround time. Length of ED stay was collected monthly beginning in the fourth quarter of 2011. Comparisons were made after Pivot implementation in the fourth quarter of 2012. RESULTS: Despite the increasing volume, the mean door-to-physician time decreased from 71 to 40 minutes, a 43.7% reduction. The overall turnaround time decreased from 220 to 181 minutes, representing approximately a 17.7% reduction. The percentage of patients who left without being seen decreased from 2.5% to 1.0%. The pivot process improved patient flow in the emergency department, reducing time spent by the patient in the department. IMPLICATIONS FOR PRACTICE: The pivot process is a viable alternative to traditional triage. Nurses are able to accurately pivot patients with a reduced amount of information.


Asunto(s)
Enfermería de Urgencia/métodos , Servicio de Urgencia en Hospital/organización & administración , Triaje/métodos , Triaje/organización & administración , Aglomeración , Humanos , Tiempo de Internación/estadística & datos numéricos , Listas de Espera
11.
Appl Nurs Res ; 28(2): 210-2, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25085809

RESUMEN

During a stay in the emergency department the treatment that cardiac patients receive can have a significant effect on health outcomes; yet, little is known about the process of care in emergency departments. In this study we examined the effect of nurse resources on the process of care in all New Jersey hospital-based emergency departments. Patient-to-nurse ratio, nurse skill mix, and Magnet accreditation were associated with aspirin on arrival and percutaneous coronary intervention within 90 minutes of arrival.


Asunto(s)
Servicio de Urgencia en Hospital , Cardiopatías/enfermería , Personal de Enfermería en Hospital , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
J Emerg Nurs ; 40(1): 13-9, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22841013

RESUMEN

INTRODUCTION: As hospitals compete for patients and their healthcare dollars, the emergency nurse is being asked to provide excellent nursing care to "customers" rather than patients. This has changed the approach in delivering quality care and has created favorable conditions for conflict as the nurse tries to achieve specific patient satisfaction goals. METHODS: A sample of 9 emergency nurses from 2 hospitals in northern New Jersey participated in focus groups designed to learn about the types of conflict commonly encountered, and to identify the attitudes and understanding of the emergency nurses experiencing conflict and how interpersonal conflict is dealt with. RESULTS: Thematic content analysis identified an overarching theme of conflicting priorities that represented a perceived disconnect between the priority of the ED leadership to achieve high patient satisfaction scores and nurses' priority to provide quality care. Three interacting sub-themes were identified: (1) staffing levels, (2) leaders don't understand, and (3) unrealistic expectations. The study also found that avoidance was the approach to manage conflict. DISCUSSION: The core conflict of conflicting priorities was based on the emergency nurses' perception that while patient satisfaction is important, it is not necessarily an indicator of quality of care. Interacting sub-themes reflect the way in which conflict priorities were influenced by patient satisfaction and the nurses' ability to provide quality care. Avoidant conflict management style was used to resolve conflicting priorities because nurses perceive that there is not enough time to address conflict even though it could impact on work stress and patient care.


Asunto(s)
Actitud del Personal de Salud , Conflicto Psicológico , Enfermería de Urgencia/métodos , Personal de Enfermería en Hospital/psicología , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Adulto , Enfermería de Urgencia/estadística & datos numéricos , Femenino , Humanos , Masculino , New Jersey , Personal de Enfermería en Hospital/estadística & datos numéricos , Atención al Paciente/métodos , Atención al Paciente/psicología , Atención al Paciente/estadística & datos numéricos , Investigación Cualitativa
13.
Blood Adv ; 8(10): 2527-2535, 2024 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-38502195

RESUMEN

ABSTRACT: FLT3 tyrosine kinase inhibitors (TKIs) have clinical efficacy for patients with FLT3-mutated AML (acute myeloid leukemia), but their impact is limited by resistance in the setting of monotherapy and by tolerability problems when used in combination therapies. FF-10101 is a novel compound that covalently binds to a cysteine residue near the active site of FLT3, irreversibly inhibiting receptor signaling. It is effective against most FLT3 activating mutations, and, unlike other inhibitors, is minimally vulnerable to resistance induced by FLT3 ligand. We conducted a phase 1 dose escalation study of oral FF-10101 in patients with relapsed and/or refractory AML, the majority of whom harbored FLT3-activating mutations and/or had prior exposure to FLT3 inhibitors. Fifty-four participants enrolled in cohorts receiving doses ranging from 10 to 225 mg per day and 50 to 100 mg twice daily (BID). The dose limiting toxicities were diarrhea and QT prolongation. Among 40 response-evaluable participants, the composite complete response rate was 10%, and the overall response rate (including partial responses) was 12.5%, including patients who had progressed on gilteritinib. Overall, 56% of participants had prior exposure to FLT3 inhibitors. The recommended phase 2 dose was 75 mg BID. FF-10101 potentially represents a next-generation advance in the management of FLT3-mutated AML. This trial was registered at www.ClinicalTrials.gov as #NCT03194685.


Asunto(s)
Leucemia Mieloide Aguda , Inhibidores de Proteínas Quinasas , Tirosina Quinasa 3 Similar a fms , Humanos , Tirosina Quinasa 3 Similar a fms/antagonistas & inhibidores , Leucemia Mieloide Aguda/tratamiento farmacológico , Persona de Mediana Edad , Femenino , Masculino , Adulto , Anciano , Inhibidores de Proteínas Quinasas/uso terapéutico , Inhibidores de Proteínas Quinasas/farmacología , Recurrencia , Mutación , Resultado del Tratamiento , Resistencia a Antineoplásicos/efectos de los fármacos , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Antineoplásicos/farmacología , Antineoplásicos/efectos adversos , Adulto Joven
14.
Am J Infect Control ; 51(12): 1295-1301, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37625547

RESUMEN

BACKGROUND: The COVID-19 pandemic has adversely impacted quality of care and patient safety. This study aimed to describe registered nurses' (RNs) perceptions on the impact of the COVID-19 pandemic on their ability to adhere to patient safety protocols using Donabedian's Health Care Quality model. METHODS: In October 2020, a survey was conducted among all actively licensed RNs in New Jersey who provided direct patient care during the first peak of COVID-19. RESULTS: Of 3,027 participants, 68% reported that the number of patients assigned impacted their ability to adhere to protocols. RNs identified a variety of organizational structures impacting adherence, including inadequate staffing, staff qualifications, and inadequate resources. Impacted processes included the inability to adhere to patient safety protocols and conduct comprehensive assessments and surveillance, the need for additional time spent on personal protective equipment and isolation policies, and difficulty maintaining isolation integrity; the need to prioritize and cluster care; and guidelines limiting personnel who could enter the room. Nurses attributed both adverse patient and staff outcomes to inadequate staffing and high patient acuity. CONCLUSIONS: These findings highlight the need for health care organizations to support frontline nursing staff in adhering to patient safety and infection prevention and control protocols during times of crises. Infection preventionists have substantial contact with bedside nurses and should leverage their collegial relationships to promote patient safety.


Asunto(s)
COVID-19 , Enfermeras y Enfermeros , Personal de Enfermería en Hospital , Humanos , Seguridad del Paciente , Pandemias/prevención & control , Calidad de la Atención de Salud , Evaluación de Procesos y Resultados en Atención de Salud
15.
Am J Infect Control ; 50(5): 572-574, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35158011

RESUMEN

Nurses play an important role in the vaccine readiness process and high vaccination rates among nurses are essential to ensuring successful vaccination programs. This study sought to examine whether the intention to get vaccinated varied by race and/or ethnicity among a large sample of registered nurses in New Jersey.


Asunto(s)
COVID-19 , Enfermeras y Enfermeros , Vacunas contra la COVID-19 , Estudios Transversales , Humanos , New Jersey , SARS-CoV-2 , Vacunación , Vacilación a la Vacunación
16.
J Neurochem ; 119(4): 805-14, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21950737

RESUMEN

The principal active constituent of the botanical drug candidate PBI-05204, a supercritical CO(2) extract of Nerium oleander, is the cardiac glycoside oleandrin. PBI-05204 shows potent anticancer activity and is currently in phase I clinical trial as a treatment for patients with solid tumors. We have previously shown that neriifolin, which is structurally related to oleandrin, provides robust neuroprotection in brain slice and whole animal models of ischemic injury. However, neriifolin itself is not a suitable drug development candidate and the FDA-approved cardiac glycoside digoxin does not cross the blood-brain barrier. We report here that both oleandrin as well as the full PBI-05204 extract can also provide significant neuroprotection to neural tissues damaged by oxygen and glucose deprivation as occurs in ischemic stroke. Critically, we show that the neuroprotective activity of PBI-05204 is maintained for several hours of delay of administration after oxygen and glucose deprivation treatment. We provide evidence that the neuroprotective activity of PBI-05204 is mediated through oleandrin and/or other cardiac glycoside constituents, but that additional, non-cardiac glycoside components of PBI-05204 may also contribute to the observed neuroprotective activity. Finally, we show directly that both oleandrin and the protective activity of PBI-05204 are blood brain barrier penetrant in a novel model for in vivo neuroprotection. Together, these findings suggest clinical potential for PBI-05204 in the treatment of ischemic stroke and prevention of associated neuronal death.


Asunto(s)
Cardenólidos/uso terapéutico , Nerium/química , Fármacos Neuroprotectores/uso terapéutico , Fitoterapia/métodos , Accidente Cerebrovascular/prevención & control , Animales , Glicósidos Cardíacos/química , Glicósidos Cardíacos/uso terapéutico , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Regulación de la Expresión Génica/efectos de los fármacos , Glucosa/deficiencia , Hipoxia/tratamiento farmacológico , Técnicas In Vitro , ATPasa Intercambiadora de Sodio-Potasio/metabolismo , Factores de Tiempo , Transfección/métodos
17.
J Am Med Dir Assoc ; 22(11): 2373-2377, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-33861979

RESUMEN

OBJECTIVE: Public reporting is a policy to improve quality and increase data transparency. The objective was to examine the association between publicly available staffing ratios and the Five-Star Quality Ratings from Nursing Home Compare over time. DESIGN: Panel data analysis. SETTING AND PARTICIPANTS: About 146 nursing homes with complete quarterly data in New Jersey between January 1, 2012, and December 31, 2019. METHODS: Using data from the State of New Jersey Department of Health and Nursing Home Compare, staff-to-resident ratios were trended for registered nurses, licensed practical nurses, and certified nursing assistants by shift and over time. Panel data analysis was used to test the association between the ratios and the ratings. RESULTS: Compared to 2012, staffing ratios improved slightly for licensed practical nurses but not for registered nurses or certified nursing assistants in 2019 (P < .001). The number of residents assigned doubled at night for all personnel. During the day and evening shifts, registered nurse staffing was significantly associated with the Nursing Home Compare staffing rating (P < .01) but not the overall rating. CONCLUSIONS AND IMPLICATIONS: Decreasing the number of residents assigned to a registered nurse in NHs results in an increase in staffing ratings. Mandatory public reporting holds nursing homes accountable for quality outcomes but does not improve staffing ratios. Quality resident care is the cumulative result of multiple measures inclusive of staffing; therefore, administrators should continue to focus on improving quality in NHs, which may improve staffing ratios across shifts.


Asunto(s)
Asistentes de Enfermería , Casas de Salud , Humanos , Admisión y Programación de Personal , Calidad de la Atención de Salud , Instituciones de Cuidados Especializados de Enfermería , Recursos Humanos
18.
Invest New Drugs ; 28(4): 402-12, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19468689

RESUMEN

Arsenic trioxide (ATO) is an inorganic arsenic derivative that is highly effective against PML-RARalpha-positive leukemia but much less against other hematological malignancies. We synthesized an organic arsenic derivative (OAD), S-dimethylarsino-thiosuccinic acid (MER1), which offers a superior toxicity profile and comparable in vitro activity relative to ATO. In Swiss Webster mice, maximally-tolerated cumulative dose of MER1 when given i.v. for 5 days was 100 mg/kg/d. We demonstrated that MER1 induced apoptosis and dose- and time-dependent inhibition of survival and growth in a panel of myeloid leukemia cell lines. Unlike ATO, this activity was independent of PML-RARalpha status and was not associated with induction of myeloid maturation. In NB4 and HL60 cells, MER1 and ATO induced caspase activation and dissipation of mitochondrial transmembrane potential. At the same time, MER1 induced generation of reactive oxygen species (ROS) and cell cycle arrest in G2/M phase and proved to be more potent than ATO at inducing apoptosis. ROS generation and intracellular glutathione levels were key modulators of MER1-induced cytotoxicity as evidenced by abrogation of apoptosis in myeloid leukemia cell lines pretreated with the disulfide bond-reducing agent dithiothreitol or the radical scavenger N-acetyl-L-cysteine. Collectively, these data indicate that MER1 induces apoptosis in PML-RARalpha-positive and -negative myeloid leukemia cells by enhancing oxidative stress. This agent, therefore, combines low in vivo toxicity with formidable in vitro pro-apoptotic ROS-mediated activity, and may represent a novel OAD suitable for clinical development against a variety of hematological malignancies.


Asunto(s)
Antineoplásicos/farmacología , Arsenicales/farmacología , Leucemia Mieloide/tratamiento farmacológico , Proteínas de Fusión Oncogénica/metabolismo , Succinatos/farmacología , Animales , Antineoplásicos/administración & dosificación , Apoptosis/efectos de los fármacos , Trióxido de Arsénico , Arsenicales/administración & dosificación , Caspasas/efectos de los fármacos , Ciclo Celular/efectos de los fármacos , Línea Celular Tumoral , Relación Dosis-Respuesta a Droga , Ensayos de Selección de Medicamentos Antitumorales , Humanos , Dosis Máxima Tolerada , Potencial de la Membrana Mitocondrial/efectos de los fármacos , Ratones , Óxidos/farmacología , Especies Reactivas de Oxígeno/metabolismo , Succinatos/administración & dosificación
19.
Leuk Lymphoma ; 61(8): 1943-1953, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32264726

RESUMEN

FF-10501-01 potently inhibits inosine-5-monophosphate dehydrogenase (IMPDH), inducing anti-proliferative and pro-apoptotic effects in acute myeloid leukemia (AML) human cell lines resistant to hypomethylating agents. In this Phase 1/2a study, Phase 1 enrolled 38 patients with relapsed/refractory AML (n = 28) or myelodysplastic syndromes (MDS/CMML, n = 10) to receive FF-10501 oral doses 50-500 mg/m2 BID for 14 or 21 days out of each 28-day cycle. Fifteen additional patients with HMA-resistant MDS/CMML (Phase 2a) were treated at 400 mg/m2 BID for 21 days. Most Phase 1 adverse events were disease-related and low-grade. 3 of 19 (16%) evaluable AML patients achieved partial remission (31, 7, and 5 months). 2 of 20 (10%) evaluable MDS/CMML patients (Phase 1 and 2a) attained marrow complete remission, one continuing treatment for 17 months. While FF-10501-01 demonstrated clinical activity and target inhibition in heavily pretreated patients with AML and MDS/CMML, increased mucositis events led to Phase 2a closure (ClinTrials.gov#NCT02193958).


Asunto(s)
Leucemia Mieloide Aguda , Síndromes Mielodisplásicos , Inhibidores Enzimáticos/efectos adversos , Humanos , IMP Deshidrogenasa , Leucemia Mieloide Aguda/tratamiento farmacológico , Síndromes Mielodisplásicos/tratamiento farmacológico
20.
Clin Cancer Res ; 26(22): 5830-5842, 2020 11 15.
Artículo en Inglés | MEDLINE | ID: mdl-32816889

RESUMEN

PURPOSE: 90Y-FF-21101 is an Yttrium-90-conjugated, chimeric mAb that is highly specific for binding to human placental (P)-cadherin, a cell-to-cell adhesion molecule overexpressed and associated with cancer invasion and metastatic dissemination in many cancer types. We report the clinical activity of 90Y-FF-21101 in a first-in-human phase I study in patients with advanced solid tumors. PATIENTS AND METHODS: The safety and efficacy of 90Y-FF-21101 were evaluated in a phase I 3+3 dose-escalation study in patients with advanced solid tumors (n = 15) over a dose range of 5-25 mCi/m2. Dosimetry using 111In-FF-21101 was performed 1 week prior to assess radiation doses to critical organs. Patients who demonstrated clinical benefit received repeated 90Y-FF-21101 administration every 4 months. RESULTS: 111In-FF-21101 uptake was observed primarily in the spleen, kidneys, testes, lungs, and liver, with tumor uptake observed in the majority of patients. Organ dose estimates for all patients were below applicable limits. P-cadherin expression H-scores ranged from 0 to 242 with 40% of samples exhibiting scores ≥100. FF-21101 protein pharmacokinetics were linear with increasing antibody dose, and the mean half-life was 69.7 (±12.1) hours. Radioactivity clearance paralleled antibody clearance. A complete clinical response was observed in a patient with clear cell ovarian carcinoma, correlating with a high tumor P-cadherin expression. Stable disease was observed in a variety of other tumor types, without dose-limiting toxicity. CONCLUSIONS: The favorable safety profile and initial antitumor activity observed for 90Y-FF-21101 warrant further evaluation of this radioimmunotherapeutic (RIT) approach and provide initial clinical data supporting P-cadherin as a potential target for cancer treatment.


Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Cadherinas/antagonistas & inhibidores , Neoplasias/radioterapia , Radioinmunoterapia , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales/inmunología , Cadherinas/genética , Cadherinas/inmunología , Antígeno Carcinoembrionario/genética , Adhesión Celular/efectos de los fármacos , Fraccionamiento de la Dosis de Radiación , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Inmunoglobulinas/inmunología , Radioisótopos de Indio/administración & dosificación , Riñón/efectos de los fármacos , Hígado/efectos de los fármacos , Pulmón/efectos de los fármacos , Masculino , Invasividad Neoplásica/genética , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias/genética , Neoplasias/inmunología , Neoplasias/patología , Bazo/efectos de los fármacos , Testículo/efectos de los fármacos , Radioisótopos de Itrio/administración & dosificación
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