Continuum of nursing education and practice: Time to close the chasm between academia and practice.

Nurses play a key role in the health of Americans. Unfortunately, the nation is expected to experience an increasing nursing shortage due to nurses retiring or leaving the profession and growing healthcare needs. In this context, it is important to prepare nursing students to be practice-ready graduates. To accomplish this goal, students must learn domain knowledge that is reflective of current nursing practices and have ample experiential learning opportunities, which require close collaboration between academia and practice in nursing education. Traditionally, faculty members who have developed nursing curriculum and the course content are mainly from within academia. The aims of the article are to describe prior efforts in academia-practice collaboration for baccalaureate-level nursing education and to propose the innovative Nursing Education and Practice Continuum model, which expands our team's successful collaborative projects. The model conceptualizes nursing education as a continuum between academia and practice, which constantly interact and evolve, and facilitates co-building and co-implementing nursing education courses for both students and practicing nurses. Nursing practice is also a continuum between experiential learning and practice after graduation. This continuum model can be implemented by aligning baccalaureate-level nursing education with the Nurse Residency Program curriculum. This article also addresses potential challenges and strategies during implementation.

Delayed visual disturbances in carbon monoxide poisoning: Identification and evaluation.

INTRODUCTION: Carbon monoxide (CO) poisoning may result in neurological and neuropsychological sequelae, including visual problems. We performed neuro-optometric evaluation on patients who reported vision or attention complaints after CO poisoning. METHODS: We performed a retrospective chart review of patients with continued symptoms after CO poisoning who had neuro-optometry evaluations between 8/18/2009 and 8/31/2013. Data collected include general demographics, symptomatic changes prompting neuro-optometric evaluation and pathologic findings during examination. RESULTS: We identified 43 CO-poisoned patients receiving neuro-optometry evaluation (17 male (40%), 26 female (60%)). The patients' mean age was 41 ± 14 years (range 17-72 years), and 28 (65%) had CO exposure durations > 24 hours. Neuro-optometry evaluations were conducted at 2.4 ± 1.7 years from poisoning (0.05-7.1). Of 37 patients reporting onset of visual symptoms, 34 reported symptom onset within six months of poisoning. Thirty-nine patients (91%) demonstrated visual pathology attributable to CO poisoning. Peripheral vision defects were detected in nine individuals (21%), while central vision defects were noted in only two (5%). Other present findings were: convergence insufficiency 28 patients (65%); oculomotor defects 14 (33%); accommodative dysfunction 10 (23%); divergence insufficiency six (14%), and convergence excess two (5%). Clinical dry eye was present in four (9%). Eleven patients (26%) received visual evoked potential (VEP) testing; eight (73%) were abnormal. CONCLUSIONS: These findings support that CO poisoning can result in visual pathology. Of clinical importance, some of these abnormalities may be responsive to rehabilitative interventions. Specialized visual evaluation and testing should be an integral aspect of care in CO-poisoned patients with visual complaints or exam findings.

Stereotypical alterations in cortical patterning are associated with maternal illness-induced placental dysfunction.

We have previously shown in mice that cytokine-mediated damage to the placenta can temporarily limit the flow of nutrients and oxygen to the fetus. The placental vulnerability is pronounced before embryonic day 11, when even mild immune challenge results in fetal loss. As gestation progresses, the placenta becomes increasingly resilient to maternal inflammation, but there is a narrow window in gestation when the placenta is still vulnerable to immune challenge yet resistant enough to allow for fetal survival. This gestational window correlates with early cortical neurogenesis in the fetal brain. Here, we show that maternal illness during this period selectively alters the abundance and laminar positioning of neuronal subtypes influenced by the Tbr1, Satb2, and Ctip2/Fezf2 patterning axis. The disturbances also lead to a laminar imbalance in the proportions of projection neurons and interneurons in the adult and are sufficient to cause changes in social behavior and cognition. These data illustrate how the timing of an illness-related placental vulnerability causes developmental alterations in neuroanatomical systems and behaviors that are relevant to autism spectrum disorders.

Appendiceal hyperemia and/or distention is not always appendicitis: appendicitis mimicry in the pediatric population.

Appendicitis is the most common surgical cause of acute abdominal pain in the pediatric population. Several conditions can mimic the clinical presentation of appendicitis, leaving imaging as an essential modality to uncover the etiology, yet under certain circumstances, it can be misleading. Here, we present three cases where findings on multidetector computerized tomography scans supported the diagnosis of appendicitis, yet an alternate cause was found. These cases highlight a particular pitfall of satisfaction of search.

Developing nursing care guidelines for children with Hodgkin's disease.

Oncology patients are generally treated on therapeutic research protocols that detail medical treatment. Nursing care is not clearly defined in these protocols; therefore, the need to develop a set of guidelines specifically for nursing care was identified. To further enhance the specialized care that our pediatric oncology patients receive, we developed nursing care guidelines to accompany specific protocols. One of our most highly accruing protocols is designed to treat patients diagnosed with Hodgkin's disease. In an effort to increase understanding of this clinical trial, decrease potential for errors, and improve overall quality of patient care, nursing care guidelines were created. To develop the nursing care guidelines, nurses created a seven-step process: (1) studied the therapeutic protocol, established ongoing interactions with the principal investigator (brainstorming), reviewed benchmarking, (2) created the first draft of the guidelines, compared the formatting of this particular set of guidelines with those previously developed at this setting (drafting), (3) field tested guidelines, (4) revised the guidelines and subjected them to additional field testing, (5) examined the guidelines for implications related to teaching tools, (6) implemented the guidelines through in-services, and (7) developed an evaluation plan with pre- and post-tests that indicated improved disease and treatment knowledge among participating nurses. Potential contributions from implementing nursing care guidelines that parallel therapeutic protocols include more accurate and complete research data collection and a more defined role for nurses in the protocol development process. The guidelines also offer a useful, detailed resource to deliver complex protocol-directed care.

Dendritic orientation and laminar architecture in the rabbit auditory thalamus.

A laminar organization composed of the dendritic fields of principal neurons and afferent axonal arbors has been proposed as the anatomical substrate for the frequency map at several levels of the mammalian central auditory system, including the inferior colliculus and medial geniculate body (MGB). In contrast to the auditory thalamus in most mammals, the ventral division of the rabbit medial geniculate body (MGV) has cellular laminae visible in routine Nissl stains, allowing a direct comparison of the laminar organization with the dendritic architecture and frequency organization. In total 30 presumptive relay neurons in the MGV were labeled with the juxtacellular recording method, and their dendritic arbors were fully reconstructed from serial sections with the aid of a computer microscope. The spatial organization of MGV dendritic fields was analyzed using the dendritic prism, dendritic stick, and fan-in projection methods. Quantitative spatial analyses revealed that, for MGV neurons in the central pars lateralis subdivision, the major axis of the dendritic fields (approximately 29 degrees relative to the horizontal plane) was closely aligned with that of the Nissl laminae (approximately 25 degrees). Both were oriented orthogonally to the tonotopic axis. In contrast, cells in the pars ovoidea had their major axis of orientation parallel to the anteroposterior axis of the brain. Although a bitufted dendritic field was the norm, it was not uncommon for MGV neurons to have pronounced spatial asymmetries in their dendritic fields. A model is presented that incorporates cellular laminae and oriented dendritic growth to form frequency-related slabs within the MGV.

Functional subregions in primary auditory cortex defined by thalamocortical terminal arbors: an electrophysiological and anterograde labeling study.

Several functional maps have been described in primary auditory cortex, including those related to frequency, tuning, latency, binaurality, and intensity. Many of these maps are arranged in a discontinuous or patchy manner. Similarly, thalamocortical projections arising from the ventral division of the medial geniculate body to the primary auditory cortex are also patchy. We used anterograde labeling and electrophysiological methods to examine the relationship between thalamocortical patches and auditory cortical maps. Biotinylated dextran-amine was deposited into physiologically characterized sites in the ventral division of the medial geniculate body of New Zealand white rabbits. Approximately 7 d later, the animal was again anesthetized and the ipsilateral auditory cortex was mapped with tungsten microelectrodes. Multi-unit physiological data were obtained for the following characteristics: best frequency (BF), binaurality, response type, latency, sharpness of tuning, and threshold. Immunocytochemical methods were used to reveal the injection site in the ventral division of the medial geniculate body as well as the anterogradely labeled thalamocortical afferents in the auditory cortex. In 86% of the cases (12 of 14), entry into a thalamocortical patch was associated with a marked change in physiological responses. A consistent BF and binaural class were usually observed within a patch. The patches appear to innervate distinct functional regions coding frequency and binaurality. A model is presented showing how patchy thalamocortical projections participate in the formation of tonotopic and binaural maps in primary auditory cortex.

Cell types and response properties of neurons in the ventral division of the medial geniculate body of the rabbit.

Although there is evidence for multiple classes of thalamic relay neurons in the auditory thalamus, correlative anatomical and physiological studies are lacking. We have used the juxtacellular labeling technique, in conjunction with Nissl, Golgi, and immunocytochemical methods, to study the morphology and response properties of cells in the ventral division of the medial geniculate body of the rabbit. Single units in the ventral division of the medial geniculate body (MGV) were characterized extracellularly with monaural and binaural tone and noise bursts (100- to 250-msec duration). Characterized units were filled with biocytin and visualized with an antibody enhanced diaminobenzidine reaction. A total of 31 neurons were physiologically characterized and labeled with the juxtacellular technique. Labeled neurons were fully reconstructed from serial sections by using a computer microscope system. Three subregions of the rabbit MGV were identified, each characterized by differences in Nissl architecture, calcium-binding protein expression, and by the dendritic orientation of tufted relay neurons. In general, the dendritic fields of relay neurons were closely aligned with the cellular laminae. Qualitative and quantitative analyses revealed two types of presumptive relay neurons within the MGV. Type I cells had thick dendrites with a greater total volume and morphologically diverse appendages compared with the Type II cells whose dendrites were thin with a moderate number of small spines. Both classes were acoustically responsive and exhibited a variety of response patterns, including onset, offset, and sustained responses. In terms of binaural characteristics, most (ca. 53%) labeled neurons were of the EE type, with the remaining cells classified as EO (27%) or EI (20%) response types. Two types of presumptive interneurons were also seen: bipolar neurons with large dendritic fields and a small neurogliaform variety. Cell types and dendritic orientation within the MGV are discussed in terms of the physiological organization of the rabbit auditory thalamus.