ABSTRACT
AIM: This study aims to describe medical-surgical registered nurses' experiences with safety culture. DESIGN: Qualitative, Inductive descriptive. METHODS: Registered nurses were recruited from a Midwestern community hospital in the United States using purposive sampling. The participants were interviewed using semi-structured interview questions from February 6, 2020-April 9, 2020. Safety huddles were observed and key documents were collected. The interviews were transcribed and analyzed using inductive qualitative content analysis. The COREQ checklist was followed. RESULTS: A total of 16 registered nurses were interviewed. Six themes emerged: Time to know my patient to keep them safe, using my gut and nursing interventions, getting extra eyes on the patient, not always having what is needed to provide safe care, organization prioritizes patient safety, and learning: have our backs. No Patient or Public Contribution.
Subject(s)
Nurses , Safety Management , Humans , United States , Qualitative Research , Patient Safety , LearningABSTRACT
AIM: The aim of this study is to describe safety culture as experienced by medical-surgical nurse leaders. BACKGROUND: Safety culture remains a barrier in safer patient care. Nurse leaders play an important role in creating and supporting a safety culture. METHODS: We used an inductive qualitative descriptive study using semistructured interviews, document review and observations in a Midwestern community hospital in the United States. RESULTS: Results of the study are as follows: making sure nurses are keeping patients safe, making sure nurses have nursing interventions in place, expecting nurses to stop unsafe acts or escalate when they feel uncomfortable, making sure nurses have what they need to provide safe care, organization prioritizes patient safety and making sure nurses are learning and growing emerged as themes describing safety culture. CONCLUSIONS: Nurse leaders made sure patients were safe by making sure everyone was doing their best to provide safe care. Insufficient time, too many priorities, insufficient resources, poor physician behaviours and lack of respect for their role emerged as barriers to leading a safety culture. IMPLICATIONS FOR NURSING MANAGEMENT: Organizations must remove barriers for nurse leaders to develop and lead a safety culture. Nurse leaders must learn to advocate successfully for safe nursing care and professional work environments.
Subject(s)
Safety Management , Workplace , Humans , United States , Qualitative Research , LeadershipABSTRACT
Cellular heterogeneity is a major cause of treatment resistance in cancer. Despite recent advances in single-cell genomic and transcriptomic sequencing, it remains difficult to relate measured molecular profiles to the cellular activities underlying cancer. Here, we present an integrated experimental system that connects single cell gene expression to heterogeneous cancer cell growth, metastasis, and treatment response. Our system integrates single cell transcriptome profiling with DNA barcode based clonal tracking in patient-derived xenograft models. We show that leukemia cells exhibiting unique gene expression respond to different chemotherapies in distinct but consistent manners across multiple mice. In addition, we uncover a form of leukemia expansion that is spatially confined to the bone marrow of single anatomical sites and driven by cells with distinct gene expression. Our integrated experimental system can interrogate the molecular and cellular basis of the intratumoral heterogeneity underlying disease progression and treatment resistance.
Subject(s)
Single-Cell Analysis/methods , Transcriptome/genetics , Animals , Cell Adhesion/genetics , Cell Adhesion/physiology , Cells, Cultured , Clustered Regularly Interspaced Short Palindromic Repeats/genetics , DNA Barcoding, Taxonomic , Humans , Mice , Sequence Analysis, RNAABSTRACT
Sex differences in the analgesic effects of morphine have been previously reported in various models that represent the sensory component of pain. However, pain sensation is a complex process that consists of both sensory and affective components. It is presently unclear whether the analgesic effects of morphine between the sensory and affective components of pain are sexually dimorphic. Moreover, differences in morphine dose-response in the two components of pain have not been examined in male and female rats. Therefore, we examined the analgesic effects of morphine on the sensory and affective components of formalin-induced pain behaviors in male and female rats. To discern the sensory component, rats were pretreated with varying doses of morphine and then intraplantar formalin-induced paw flinches were measured. Morphine reduced the number of formalin-induced paw flinches at a treatment dose of 4.0mg/kg. Morphine analgesia was similar across the sexes in the early (phase 1) and late phase (phase 2) of the formalin test. To examine the affective component, rats were pretreated with varying doses of morphine, and then intraplantar formalin-induced conditioned place aversion (CPA) was examined. Formalin produced CPA, which was blocked by morphine at doses of 1.0mg/kg and higher in male and female rats. Lastly, formalin-induced cFos expression and the effects of systemic morphine were examined in the superficial dorsal horn of the spinal cord. Intraplantar formalin produced robust expression of cFos; however, morphine did not attenuate the cFos expression. These results demonstrate a notable dissociation of the analgesic effects of morphine by detecting a fourfold shift in the minimum effective dose between the sensory and affective components of formalin-induced spontaneous pain, that were similar between male and female rats. The findings further suggest disparate mechanisms involved in systemic morphine-induced analgesia in the two components of formalin-induced pain.
Subject(s)
Affect/drug effects , Analgesics, Opioid/pharmacology , Morphine/pharmacology , Pain Perception/drug effects , Pain/drug therapy , Pain/physiopathology , Affect/physiology , Animals , Avoidance Learning/drug effects , Avoidance Learning/physiology , Conditioning, Psychological/drug effects , Conditioning, Psychological/physiology , Dose-Response Relationship, Drug , Female , Formaldehyde , Immunohistochemistry , Lumbar Vertebrae , Male , Pain/pathology , Pain/psychology , Pain Measurement , Pain Perception/physiology , Posterior Horn Cells/drug effects , Posterior Horn Cells/metabolism , Posterior Horn Cells/pathology , Proto-Oncogene Proteins c-fos/metabolism , Rats, Sprague-Dawley , Sex Characteristics , Spatial Behavior/drug effects , Spatial Behavior/physiologyABSTRACT
EPHB4, an ephrin type B receptor, is implicated in the growth of several epithelial tumors and is a promising target in cancer therapy; however, little is known about its role in hematologic malignancies. In this article, we show that EPHB4 is highly expressed in â¼30% of acute myeloid leukemia (AML) samples. In an unbiased RNA interference screen of primary leukemia samples, we found that EPHB4 drives survival in a subset of AML cases. Knockdown of EPHB4 inhibits phosphatidylinositol 3-kinase/AKT signaling, and this is accompanied by a reduction in cell viability, which can be rescued by a constitutively active form of AKT. Finally, targeting EPHB4 with a highly specific monoclonal antibody (MAb131) is effective against AML in vitro and in vivo. EPHB4 is therefore a potential target in AML with high EPHB4 expression.