An in vitro assay to study induction of the regenerative state in sensory neurons.

After injury, peripheral neurons activate a pro-regenerative program that facilitates axon regeneration. While many regeneration-associated genes have been identified, the mechanism by which injury activates this program is less well understood. Furthermore, identifying pharmacological methods to induce a pro-regenerative state could lead to novel treatments to repair the injured nervous system. Therefore, we have developed an in vitro assay to study induction of the pro-regenerative state following injury or pharmacological treatment. First, we took advantage of the observation that dissociating and culturing sensory neurons from dorsal root ganglia activates a pro-regenerative program. We show that cultured neurons activate transcription factors and upregulate regeneration-associated genes common to the pro-regenerative program within the first hours after dissection. In a paradigm similar to pre-conditioning, neurons injured by dissociation display enhanced neurite outgrowth when replated as early as 12h after being removed from the animal. Furthermore, stimulation of the pro-regenerative state improves growth on inhibitory substrates and requires DLK/JNK signaling, both hallmarks of the pro-regeneration response in vivo. Finally, we modified this assay in order to identify new methods to activate the pro-regenerative state in an effort to mimic the pre-conditioning effect. We report that after several days in culture, neurons down-regulate many molecular hallmarks of injury and no longer display enhanced neurite outgrowth after replating. Hence, these neurons are functionally naïve and are a useful tool for identifying methods to induce the pro-regenerative state. We show that both injury and pre-treatment with forskolin reactivate the pro-regenerative state in this paradigm. Hence, this assay is useful for identifying pharmacological agents that induce the pro-regenerative state in the absence of injury.

Delivery room management of very low birth weight infants in Germany, Austria and Switzerland--a comparison of protocols.

BACKGROUND: Surveys from the USA, Australia and Spain have shown significant inter-institutional variation in delivery room (DR) management of very low birth weight infants (VLBWI, <1500g) at birth, despite regularly updated international guidelines. OBJECTIVE: To investigate protocols for DR management of VLBWI in Germany, Austria and Switzerland and to compare these with the 2005 ILCOR guidelines. METHODS: DR management protocols were surveyed in a prospective, questionnaire-based survey in 2008. Results were compared between countries and between academic and non-academic units. Protocols were compared to the 2005 ILCOR guidelines. RESULTS: In total, 190/249 units (76%) replied. Protocols for DR management existed in 94% of units. Statistically significant differences between countries were found regarding provision of 24 hr in house neonatal service; presence of a designated resuscitation area; devices for respiratory support; use of pressure-controlled manual ventilation devices; volume control by respirator; and dosage of Surfactant. There were no statistically significant differences regarding application and monitoring of supplementary oxygen, or targeted saturation levels, or for the use of sustained inflations. Comparison of academic and non-academic hospitals showed no significant differences, apart from the targeted saturation levels (SpO2) at 10 min. of life. Comparison with ILCOR guidelines showed good adherence to the 2005 recommendations. SUMMARY: Delivery room management in German, Austrian and Swiss neonatal units was commonly based on written protocols. Only minor differences were found regarding the DR setup, devices used and the targeted ranges for SpO2 and FiO2. DR management was in good accordance with 2005 ILCOR guidelines, some units already incorporated evidence beyond the ILCOR statement into their routine practice.

Capability of mucoid Pseudomonas aeruginosa to survive in chlorinated water.

Mucoid strains of Pseudomonas aeruginosa are characterized by an overproduction of the extracellular polysaccharide alginate. When suspended into chlorinated swimming-pool water or drinking water samples, mucoid bacteria revealed enhanced survival compared with isogenic nonmucoid cells. Removal of slime from mucoid bacteria abolished chlorine resistance, addition of purified alginate to washed bacteria again enhanced survival. Thus, alginate-containing slime confers protection on P. aeruginosa against chlorine and may contribute to survival of these bacteria in chlorinated water systems.

Describing the work of nursing: the case of postsurgical nursing interventions for men with prostate cancer.

Nursing interventions were provided to older men following prostate surgery during a controlled clinical trial examining nursing care and its effects on quality of life outcomes. The Nursing Intervention Lexicon and Taxonomy (NILT), consisting of 7 categories of nursing interventions, was used to classify intervention statements extracted from 32 home care records. Two major categories of interventions were patient teaching (45%) and psychologically based interventions (20%). In a comparison of the types of interventions provided upon discharge from the hospital with those provided at the end of 1 month of home care, it appeared that patients had not yet shifted from the crisis to the chronic phase of their illness course based on Rolland's framework.

Measuring patient opinion of pain management.

Pain management has been increasingly recognized as an important indicator of quality patient care. In this article, we describe the development of a measure of patients' perception of pain management. Based upon the American Pain Society's guidelines, the six-item Patient Opinion of Pain Management (POPM) scale demonstrated promising internal consistency, reliability, and validity in a sample of 241 patients from 11 hospitals. The POPM is discussed in the context of previous research on the assessment of pain management.

The construct of thriving in pregnancy and postpartum.

This article explores the construct of thriving as an integration of nutritional (manifested in weight), psychosocial, and lifestyle concerns of childbearing within the context of Orem's self-care deficit theory. Provisional definitions of thriving in pregnancy and postpartum are proposed. Preliminary dimensions of thriving in postpartum are based on factor analysis of weight, lifestyle, and psychosocial data from 145 women after childbirth. Four dimensions emerged: psychosocial distress, lifestyle patterns, a weight factor, and a body image factor. Although the dimensionality of postpartal thriving reported is preliminary, it provides a beginning foundation for assessment and intervention for postpartal women.

Nursing terminology: a comparison of the ICNP and the nursing intervention lexicon and taxonomy.

The purpose of this paper is to provide an overview of nursing terminology work done to date and to compare the labels and subsumed terms of the recent alpha version of the International Classification of Nursing Practice (ICNP) with the verb terms (n = 147) of the interventions in a dataset of interventions (n = 7292) categorized using the Nursing Intervention Lexicon and Taxonomy (NILT). Two estimates were used to evaluate the adequacy of the ICNP terms for representing intervention terminology. Term matches were done using the NILT categories most similar to the ICNP action types. The ICNP action type 'observing' (and its subsumed terms) was best, accounting for 20% of the NILT verbs. The ICNP label 'observing' (and its subsumed terms) ranked first in accounting for 69% of the interventions in the NILT categories (CND & CV). The remaining action types had many fewer matches for the verbs and interventions in the NILT dataset. Thus it is possible to conclude that a relatively small subset of the verb terms, and interventions in a dataset of natural language interventions categorized using NILT have been captured by the INCP alpha version of Axis A.

Clinical data for use in assessing quality: lessons learned from the Texas Nurses' Association Report Card Project.

The purpose of this report is to describe the Texas Nurses' Association Report Card Project. As part of ANA's Safety and Quality Initiative, the project was designed as a feasibility study to determine whether clinically based quality indicator data could be collected in standard ways across acute care agencies in Texas. Clinicians from 12 agencies, under leadership of the professional association (Texas Nurses' Association), participated in this initial effort to reach consensus on clinical indicator definitions and on how to collect clinical data for each indicator. Data were collected for falls and injuries, bacteremias, pressure ulcers, skill mix, nursing hours per patient day, patient satisfaction (with nursing, hospital stay, education, and pain management), and nurse satisfaction. The process used is described, as well as the findings and the lessons learned. The importance of standard definitions and precise and standard primary sources for the data are emphasized for the phase II report card efforts to follow.

Nursing intervention intensity and focus: indicators of process for outcomes studies.

Outcomes research has become increasingly important in the current health care environment and for informatics research efforts. Recent efforts in automating clinical data for use in outcomes studies has focused attention on the need to represent the processes of care in the classic structure-process-outcome models of care. This paper reports on use of the Nursing Intervention Lexicon and Taxonomy for classifying interventions to characterize two process of care variables: intervention intensity and intervention focus. Study results demonstrate that these variables are descriptive and provide promise for describing processes of nursing care for describing clinical care.

The nursing intervention lexicon and taxonomy: implications for representing nursing care data in automated patient records.

The article discusses how the Nursing Intervention Lexicon and Taxonomy (NILT) is being used to describe patterns of care for patients receiving home care nursing. These patterns of care include intensity (frequency of interventions), focus of care (NILT category or categories with the highest percentage of interventions), and comprehensiveness of care (number of NILT intervention categories reflected). Thus with a means for quantifying care in holistic ways, nurses can now ask important questions about clinical care and its outcomes using empirical nursing data about care (i.e., categorized nursing intervention statements). Understanding how these data are expressed using nurses' natural language terms, and being able to categorize these interventions reliably, represent essential preliminary work for describing and defining data for inclusion in the automated record.

Characterization of mucoid Pseudomonas aeruginosa strains isolated from technical water systems.

The occurrence of mucoid Pseudomonas aeruginosa strains was investigated in water samples and surface material from non-clinical aquatic environments. Ten of 81 environmental isolates displayed a mucoid colony type after incubation at 36 degrees C for 24 h on Pseudomonas Isolation Agar. The mucoid strains obtained exclusively from surfaces of technical water systems were characterized in terms of medium-dependent expression of mucoid colonial phenotype, exoenzyme profile, pigment production and O-antigen type. The mucoid strains secreted substantially higher quantities of carbohydrate and uronic acid-containing material compared to non-mucoid environmental isolates. Major slime components of the mucoid strains were identified as O-acetylated alginates that contained higher proportions of mannuronate than guluronate monomer residues and were composed of blocks of poly-mannuronate and poly-mannuronate/guluronate, whereas blocks of poly-guluronate were absent. The results suggest that surfaces in aquatic environments may represent a natural habitat for mucoid (i.e. alginate-overproducing) strains of Ps. aeruginosa with properties similar to clinical mucoid strains.

Expert system development in nursing: implications for critical care nursing practice.

OBJECTIVE: To obtain information about how highly experienced critical care nurses reason to plan care and make decisions about a critically ill unstable patient, and to determine the usefulness of this information for expert system development. DESIGN: Descriptive, using think-aloud technique and protocol analysis. SETTING: Laboratory. PATIENT: A simulated patient case whose condition deteriorated over a 12-hour shift. The case depicted an elderly female with congestive heart failure and atrial fibrillation with rapid ventricular response. RESULTS: Protocol analysis revealed the information (data) that subjects used and how they structured that information to plan care and make decisions. Examination of subjects' reasoning processes allowed the investigators to identify "if-then" rules that could be used in expert system design. CONCLUSIONS: The reasoning processes identified would assist in expert system development. An expert system designed to represent experienced critical care nurses' knowledge and reasoning processes would preserve that expertise in a computer system that could then be used to assist less experienced nurses to improve their reasoning skills and strategies.

Nursing Informatics: State of the Science.

Nursing informatics is a combination of computer science, information science and nursing science designed to support the practice and delivery of patient care. Using the informatics model of data, information and knowledge, the nature of automated systems to support clinicians in their delivery of high-quality care are described from their inception to their current state, and the importance of research to advance the state of nursing knowledge are emphasized. The evolution of clinical care systems and nursing management systems are viewed,as is the progress of the scientific work relative to nursing informatics. Milestones in the advancing state of the science are identified and the conclusion is drawn that although nursing informatics has evolved, much scientifically based work remains. Key nursing informatics resources identified in the paper support this conclusion about what remains to be accomplished.

The conceptual validity of a taxonomy of nursing interventions.

The purpose of this paper is to report validity evidence for the nursing intervention taxonomy developed as part of the Nursing Intervention Lexicon and Taxonomy (NILT) Study. Using eclectic classification methods of library science, cognitive science, nursing science and computational linguistics, a taxonomy of nursing interventions consisting of seven categories was developed. These categories which incorporate care as a central concept are described and defined, and prototypical examples of each category are presented. Brinberg & McGrath's validity schema provides the framework within which evidence for validity as value, validity as correspondence and validity as generalizability were examined. Comparison of the NILT categories with previously published categorizations of nursing functions and interventions provides strong support for the validity of this classification. Additionally, comparison of the NILT categories with two internationally derived categorizations of nursing functions supports the robustness or generalizability of the NILT classification.

Expert nurses' clinical reasoning under uncertainty: representation, structure, and process.

How do expert nurses reason when planning care and making clinical decisions for a patient who is at risk, and whose outcome is uncertain? In this study, a case study involving a critically ill elderly woman whose condition deteriorated over time, was presented in segments to ten expert critical care nurses. Think aloud method was used to elicit knowledge from these experts to provide conceptual information about their knowledge and to reveal their reasoning processes and problem-solving strategies. The verbatim transcripts were then analyzed using a systematic three-step method that makes analysis easier and adds creditability to study findings by providing a means of retracing and explaining analysis results. Findings revealed information about how patient problems were represented during reasoning, the manner in which experts subjects structured their plan of care, and the reasoning processes and heuristics they used to formulate solutions for resolving the patient's problems and preventing deterioration in the patient's condition.

A descriptive analysis of experienced nurses' clinical reasoning during a planning task.

A Think Aloud (TA) method was employed to collect verbal data from seven clinical nurses as they reviewed a written case study and formulated a plan of care. Protocol Analysis (PA) of the verbal data resulted in a visual representation of each subject's plan of care and provided information regarding the clinical data that subjects used to plan care. The results demonstrated that frequently problems and interventions were inextricably linked and considered in unison rather than during separate steps of a planning process. This finding has implications relative to the current practice within both nursing education and nursing service of focusing on problems and interventions separately when planning care.

Nursing intervention lexicon and taxonomy study: language and classification methods.

Research on nursing informatics to establish a Nursing Intervention Lexicon and Taxonomy is described. The rationale for using classification and language-based methods in establishing and validating a lexicon and taxonomy for use with automated systems is provided. The importance of designing automated systems with language-based analyses capabilities is emphasized.