Evidence-based nursing: the role of the advanced practice registered nurse in the management of heart failure patients in the outpatient setting.

Heart failure (HF) is a chronic debilitating illness that affects millions of Americans each year. Patients with HF are faced with chronic physical symptoms, emotional strain, and significant socioeconomic burden. Goals in the management of HF are to slow the disease progression, decrease symptom acuity, and prevent exacerbations that lead to hospital readmission. Management of HF remains a challenge for healthcare providers. There is a fine balance between optimizing patient functioning and minimizing healthcare expenditures. With the incidence of HF increasing annually, it is important to have effective disease management strategies in place. In any disease management program, it is important to follow those guidelines outlined by evidence-based practice. The purpose of this systematic review was to evaluate current evidence-based practice and determine what benefit exists of having an advanced practice registered nurse assist in the management of patients with HF.

Primary herpes simplex virus type 1 infection of the eye triggers similar immune responses in the cornea and the skin of the eyelids.

Herpetic stromal keratitis (HSK) and blepharoconjunctivitis in humans are thought partly to result from immunopathological responses to herpes simplex virus type 1 (HSV-1). The corneas of NIH mice were inoculated with HSV-1 (strain McKrae) and mice were examined for signs of disease and infection on days 1, 4, 7, 10, 14 and 21. The eyes and eyelids of infected and control mice were processed for immunohistochemistry and double stained for viral antigens and one of the following cell surface markers (Gr-1, F4/80, CD4, CD8, CD45R or MHC class II) or one of the following cytokines (IL-2, IL-4, IL-6, IL-10, IL-12 or IFN-gamma). All infected mice developed signs of HSK by day 4 and blepharitis by day 7 and these both persisted until day 21, when signs of resolution where apparent. Virus was detected during the first week of infection and became undetectable by day 10. Large numbers of Gr-1(+) cells (neutrophils) infiltrated infected corneas and eyelids in areas of viral antigen and CD4(+) T cells increased significantly in number after virus clearance. In both sites, the predominant cytokines were IL-6, IL-10, IL-12 and IFN-gamma, with few IL-2(+) and IL-4(+) cells. These observations suggest that the immune responses in the cornea are similar to those in the eyelids but, overall, the responses are not clearly characterized as either Th1 or Th2. In both sites, the neutrophil is the predominant infiltrating cell type and is a likely source of the cytokines observed and a major effector of the disease process.