Informatics Experience Can Help Predict Doctor of Nursing Practice Student Mastery of Informatics Competencies.

With information technology increasingly guiding nursing practice, Doctor of Nursing Practice students must be prepared to use informatics to optimize patient outcomes despite their varied experience and education. Understanding how students' baseline experience affects their mastery of informatics competencies could help faculty design Doctor of Nursing Practice course content. Therefore, the aim of this retrospective descriptive study was to evaluate whether Doctor of Nursing Practice students' baseline informatics experience affected their mastery of four competencies: meaningful use, datasets, e-health, and clinical support systems. Participants were Doctor of Nursing Practice students (n = 55) enrolled in an online informatics course. Participant experience was compared to competency mastery using χ tests. Logistic regression was performed to assess the effect of experience and highest degree obtained on competency mastery. Analysis revealed that participants with meaningful use experience were significantly more likely to master the meaningful use competency than were those without it. Relevant experience did not predict mastery of dataset competencies. Participants with e-health experience were significantly more likely to master the e-health competency (applying e-health resources to vulnerable patients' learning needs). While not significant, a greater percentage of students with clinical support systems experience mastered the clinical support systems competency. Informatics courses might need to be designed to address students' needs based on their experience.

Characterization of Spatial Learning and Sickness Responses in Aging Rats Following Recurrent Lipopolysaccharide Administration.

Infections in older individuals can result in cognitive function decline, yet research is limited on how recurrent infections affect cognitive responses. Activation of the immune system results in sickness responses mediated by cytokines. This pilot study examined effects of a model of recurrent infection in aged, male Brown Norway rats on sickness responses, including spatial learning, and cytokine levels. To model initial and recurrent infection, 300 µg/kg lipopolysaccharide (LPS) or saline was administered 1/day for 2 consecutive days during 2 weeks separated by 16 days. Testing occurred for 6 days during each LPS injection week using the Morris water maze, a measure used to evaluate spatial learning. Directional heading error (DHE) and swim time latency served as spatial learning indices. Retention tests and probe trials assessed memory. Plasma cytokine levels were assessed 5 and 24 hr after each LPS injection during Week 2. While food intake and weight decreased significantly in LPS-injected rats compared to controls during Week 1, both displayed increased DHE. Despite exhibiting lessened sickness behaviors during Week 2, experimental animals still displayed spatial learning deficits. Probe trials revealed memory deficits in LPS-injected animals. Interleukin 6 level was higher in the experimental group 5 and 24 hr after LPS injection on Day 1 compared to Day 2 and higher in the experimental compared to the control group at 5 hr on Day 1. Cognitive effects were dissociated from metabolic effects in aged rats, with recurring LPS exposure resulting in persistent cognitive impairment despite decreased sickness responses. Further research with older individuals is warranted.

Improving patient education about tobacco withdrawal and nicotine gum use by registered nurses in inpatient psychiatry: A feasibility study.

WHAT IS KNOWN ON THE SUBJECT?: Many psychiatric inpatients use tobacco, but most psychiatric hospital units prohibit tobacco use. Psychiatric nurses do not receive adequate education about how to teach patients to best manage tobacco withdrawal symptoms. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Psychiatric nurses who receive a brief educational intervention about tobacco withdrawal symptoms and best practices for using nicotine gum may be more prepared to teach patients about these topics. In turn, patients may use nicotine gum more often during their hospitalization, leading to improved outcomes for them as well as for staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A simple educational intervention aimed at psychiatric nurses can result in positive outcomes for psychiatric inpatients who use tobacco. Patients who have a positive experience with stopping tobacco use while hospitalized may be more likely to commit to lifelong tobacco cessation afterwards. The results of this feasibility study demonstrate that additional research that builds on the work presented here is warranted. ABSTRACT: Introduction Tobacco use is prohibited in most psychiatric facilities in the United States, yet many psychiatric inpatients are tobacco users. Psychiatric nurses have reported inadequate education about best practices for managing tobacco dependence. Aim To explore the feasibility of an educational intervention for psychiatric nurses designed to improve their ability to educate patients about best practices for managing tobacco dependence, as well as effective use of nicotine gum. Method Fourteen nurses on a psychiatric inpatient unit at a community hospital were educated about the targeted topics. Chart reviews of nonequivalent pre-intervention and post-intervention patient groups were conducted to explore the outcomes of the intervention. Results Patients received more teaching, and used nicotine gum more often, following the intervention. However, no statistically significant differences between the pre-intervention and post-intervention patient groups were found. Discussion Educating nurses about best practices for managing tobacco withdrawal symptoms may have positive outcomes. Existing research suggests that such interventions may be most effective when support and structure are provided to ensure long-term practice changes. Implications for practice This feasibility study demonstrates that a brief nurse education intervention has the potential to improve the experience of tobacco withdrawal for psychiatric inpatients. Future research that expands upon the current project is warranted.

Different Sickness Responses in Adult and Aged Rats Following Lipopolysaccharide Administration.

OBJECTIVE: Immune challenges result in sickness responses such as decreased activity, fever, and spatial learning deficits. While these responses occur simultaneously, they are not usually evaluated concurrently or for an extended time. The purpose of this study was to examine how an immune challenge affected activity and temperature responses in animals tested concurrently in the Morris water maze (MWM) over 5 days and how aging interacts with such responses. METHOD: An accepted model of aging, adult ( n = 10; 5-6 months) and aged ( n = 7; 22 months) male Brown-Norway rats were implanted with a telemetry device (Mini Mitter, Oakmont, PA) to continuously monitor temperature and activity following an immune challenge. These animals were injected with either 250 µg/kg lipopolysaccharide (LPS) or 0.9% sodium chloride and then assessed in the MWM for 5 days. RESULTS: Temperature responses varied by age. Initial temperatures decreased in both experimental groups followed by an increase (fever) in the adult group, while the temperatures of the aged animals remained decreased. Although both age groups were sedentary at baseline, activity decreased after LPS only in the adult group. CONCLUSION: An LPS immune challenge resulted in age-dependent temperature and activity changes. There was an absence of fever and no effect on activity in aged LPS-treated animals. These results may suggest the need to assess a broader spectrum of sickness responses when monitoring elderly individuals for infection and not rely on the presence of fever. Activity may not be a sensitive indicator of sickness in some aging models.

Spatial Learning Responses to Lipopolysaccharide in Adult and Aged Rats.

Sickness behaviors, adaptive responses to infections, include lethargy, depression, reduced eating and grooming, and concentration problems resulting from interactions between the immune and neuroendocrine systems. Detecting these responses is especially critical in the elderly, as the infections that cause them can lead to cognitive impairment. While deficits in spatial learning, a hippocampal-dependent form of learning, are part of the sickness response, directional heading errors (DHEs; an indicator of spatial-learning deficits) and their time trajectories need further examination. Therefore, we simultaneously investigated the time trajectory of age-dependent sickness responses and spatial learning over 5 days in adult (5-6 months) and aged (22 months) male Brown-Norway rats injected with 250 µg/kg lipopolysaccharide (LPS; experimental group) or 0.9% sodium chloride (control group). LPS administration resulted in pronounced, age-dependent weight loss and decreased food intake that persisted in the aged group. Animals were tested for 5 days (trial) in the Morris water maze. After 7 days of rest, animals were retested for 2 days (retention). Adult and aged LPS-treated animals displayed greater differences in mean DHE than the control groups, indicating that they exhibited more DHE over the trial days. Experimental groups did not show consistent DHE improvement until Day 4 (adult) or 5 (aged). LPS had no effect on probe or retention trials. We conclude that LPS activation of the immune system results in a selective, age-dependent impairment in spatial learning, decreased food intake, and weight loss. All of these results are prolonged in aged animals.

Effects of low-dose lipopolysaccharide and age on spatial learning in different Morris water maze protocols.

OBJECTIVES: Animals administered lipopolysaccharide exhibit dose-related sickness behaviors (decreased food intake, weight loss, and cognitive changes). While research has demonstrated that spatial learning is impaired following a lipopolysaccharide immune challenge, the results differ depending on the methodology used to evaluate spatial learning. Additionally, few studies have evaluated the effects of low-dose lipopolysaccharide on spatial learning. Therefore, we assessed spatial learning, food intake, and weight changes in adult and aged rats after a low-dose lipopolysaccharide immune challenge in the Morris water maze using two water temperatures. METHODS: Adult (5-6 months) and aged (22 months) male Brown-Norway rats were administered either 50 or 100 µg/kg lipopolysaccharide or saline, and then tested in the Morris water maze for 5 days, rested for 7 days, and later underwent 2 days of retention tests. Probe trials were conducted at the end of initial and retention testing. RESULTS: Low-dose lipopolysaccharide administration did not result in food intake or weight changes. While the aged experimental group took longest to improve directional heading error in both cold and warm water, heading error was greater in cold water. Behavioral testing revealed an apparent age and water temperature effect on swim time. Retention and probe trial results showed that aged experimental animals had the worst performance in cold water. CONCLUSION: We conclude that while low-dose lipopolysaccharide did not result in typical sickness behaviors (decreased food intake or weight), spatial learning and memory were impaired in the aged experimental group. These results have important implications for the care of elderly individuals experiencing mild to moderate infections.

Evaluation of Doctor of Nursing Practice Students' Competencies in an Online Informatics Course.

BACKGROUND: Doctor of Nursing Practice (DNP) programs have experienced rapid growth across the United States. With the expansion of electronic health records, DNP students are expected to acquire the knowledge and skills needed to manage data and apply informatics concepts. However, little information exists to help faculty evaluate student competency in these areas. METHOD: This retrospective analysis evaluated the competencies of a convenience sample of DNP students enrolled in an online informatics course. Two areas were assessed in this study: acquisition of informatics skills, and analysis or application of informatics concepts. RESULTS: Regarding informatics skills, postbaccalaureate students performed better than post-master's students. In analysis and application of informatics concepts, post-master's students performed better than postbaccalaureate students. CONCLUSION: Different educational strategies may need to be created to meet the varying needs of postbaccalaureate and post-master's students in DNP programs. [J Nurs Educ. 2017;56(6):364-367.].

The role of macrophages in the clearance of inhaled ultrafine titanium dioxide particles.

The role of macrophages in the clearance of particles with diameters less than 100 nm (ultrafine or nanoparticles) is not well established, although these particles deposit highly efficiently in peripheral lungs, where particle phagocytosis by macrophages is the primary clearance mechanism. To investigate the uptake of nanoparticles by lung phagocytes, we analyzed the distribution of titanium dioxide particles of 20 nm count median diameter in macrophages obtained by bronchoalveolar lavage at 1 hour and 24 hours after a 1-hour aerosol inhalation. Differential cell counts revealing greater than 96% macrophages and less than 1% neutrophils and lymphocytes excluded inflammatory cell responses. Employing energy-filtering transmission electron microscopy (EFTEM) for elemental microanalysis, we examined 1,594 macrophage profiles in the 1-hour group (n = 6) and 1,609 in the 24-hour group (n = 6). We found 4 particles in 3 macrophage profiles at 1 hour and 47 particles in 27 macrophage profiles at 24 hours. Model-based data analysis revealed an uptake of 0.06 to 0.12% ultrafine titanium-dioxide particles by lung-surface macrophages within 24 hours. Mean (SD) particle diameters were 31 (8) nm at 1 hour and 34 (10) nm at 24 hours. Particles were localized adjacent (within 13-83 nm) to the membrane in vesicles with mean (SD) diameters of 592 (375) nm at 1 hour and 414 (309) nm at 24 hours, containing other material like surfactant. Additional screening of macrophage profiles by conventional TEM revealed no evidence for agglomerated nanoparticles. These results give evidence for a sporadic and rather unspecific uptake of TiO(2)-nanoparticles by lung-surface macrophages within 24 hours after their deposition, and hence for an insufficient role of the key clearance mechanism in peripheral lungs.