Artemin sensitizes nociceptors that innervate the osteoarthritic joint to produce pain.

OBJECTIVE: There have been significant developments in understanding artemin/GFRα3 signaling in recent years, and there is now accumulating evidence that artemin has important roles to play in pain signaling, including that derived from joint and bone, and that associated with osteorthritis (OA). METHODS: A total of 163 Sprague-Dawley rats were used in this study. We used an animal model of mono-iodoacetate (MIA)-induced OA, in combination with electrophysiology, behavioral testing, Western blot analysis, and retrograde tracing and immunohistochemistry, to identify roles for artemin/GFRα3 signaling in the pathogenesis of OA pain. RESULTS: We have found that: 1) GFRα3 is expressed in a substantial proportion of knee joint afferent neurons; 2) exogenous artemin sensitizes knee joint afferent neurons in naïve rats; 3) artemin is expressed in articular tissues of the joint, but not surrounding bone, early in MIA-induced OA; 4) artemin expression increases in bone later in MIA-induced OA when pathology involves subchondral bone; and 5) sequestration of artemin reverses MIA-induced sensitization of both knee joint and bone afferent neurons late in disease when there is inflammation of knee joint tissues and damage to the subchondral bone. CONCLUSIONS: Our findings show that artemin/GFRα3 signaling has a role to play in the pathogenesis of OA pain, through effects on both knee joint and bone afferent neurons, and suggest that targeted manipulation of artemin/GFRα3 signaling may provide therapeutic benefit for the management of OA pain. DATA AVAILABILITY: Data are available on request of the corresponding author.

Natural Microbial Exposure from the Earliest Natural Time Point Enhances Immune Development by Expanding Immune Cell Progenitors and Mature Immune Cells.

Microbial experience fundamentally shapes immunity, particularly during the perinatal period when the immune system is underdeveloped, and novel microbial encounters are common. Most animal models are raised in specific pathogen-free (SPF) conditions with relatively uniform microbial communities. How SPF housing conditions alter early-life immune development relative to natural microbial exposure (NME) has not been thoroughly investigated. In this article, we compare immune development in SPF-raised mice with mice born from immunologically experienced mothers in microbially diverse environments. NME induced broad immune cell expansion, including naive cells, suggesting mechanisms besides activation-induced proliferation contribute to the increase in immune cell numbers. We found NME conditions also expanded immune cell progenitor cell populations in the bone marrow, suggesting microbial experience enhances immune development at the earliest stages of immune cell differentiation. Multiple immune functions characteristically impaired in infants were also enhanced by NME, including T cell memory and Th1 polarization, B cell class switching and Ab production, proinflammatory cytokine expression, and bacterial clearance after Listeria monocytogenes challenge. Collectively, our studies reveal numerous impairments in immune development in SPF conditions relative to natural immune development.

Cognitive behavioral social rhythm group therapy versus present centered group therapy for veterans with posttraumatic stress disorder and major depressive disorder: A randomized controlled pilot trial.

BACKGROUND: Cognitive Behavioral Social Rhythm Group Therapy (CBSRT) is a chronobiologically-informed group therapy designed to stabilize social rhythms in veterans with comorbid combat-related PTSD and major depressive disorder (MDD). This randomized controlled pilot trial is the first to examine feasibility and preliminary efficacy of group CBSRT as compared to group Present Centered Therapy (PCT), a well-characterized active attention, psychotherapy condition. METHODS: A total of 43 male veterans with combat-related PTSD, MDD, and disruptions in sleep or daily routine were randomly assigned to CBSRT or PCT. Therapy was provided weekly in a group modality for 12 weeks. Follow-up feasibility and gold-standard PTSD, MDD, and subjective/objective sleep assessments were conducted at post-treatment, 3 months, and 6 months post-treatment. RESULTS: Feasibility results demonstrated that veterans assigned to CBSRT had higher rates of attendance than veterans assigned to PCT. Both CBSRT and PCT were associated with improvements in PTSD and MDD symptoms, sleep efficiency, and number of awakenings; there were no differences between group therapies on these indices. Veterans in the CBSRT group had a greater reduction in the number of nightmares than veterans in the PCT group. LIMITATIONS: Preliminary results must be qualified by the small sample size. CONCLUSIONS: Group CBSRT may be more feasible for veterans than PCT. Both CBSRT and PCT were associated with improvements in psychiatric symptoms with few differences between conditions. CBSRT is a promising new group therapy that may help address the high-rate of PTSD therapy attrition in combat veterans. CLINICAL TRIAL REGISTRATION: NCT00984698.

Exploring a child's-eye view of NHS healthcare.

Parental feedback has long shaped NHS care, but until recently there has been little evidence gathered about patient experiences through the eyes of children. But as Bridget Hopwood and Sarah-Ann Burger write, change is under way.

They Are Called Nursing Homes for a Reason: RN Staffing in Long-Term Care Facilities.

According to the Centers for Medicare and Medicaid Services (CMS), the Consolidated Medicare and Medicaid regulations have not been systematically reviewed and updated since 1991. Existing regulations require that, with certain exceptions, an RN provide services in a facility for 8 consecutive hours per day, 7 days per week; licensed practical nurses (LPNs) 24 hours per day; and sufficient staff to meet residents' needs. The requirements to determine "sufficient" staff remain undefined by CMS. Several national organizations support RN staffing 24 hours per day each day of the week (24/7). These organizations provided evidence refuting CMS' position that it does not have sufficient information at this time to require a specific number of staff or hours of nursing care per resident. Consideration should be given to the Institute of Medicine recommendation affrming the need for and requiring the presence of at least one RN within every nursing home facility at all times. Currently, there is a bill in the House of Representatives that supports 24/7 RN coverage in nursing homes, which must become both bipartisan and bicameral to be passed.

Gerontological nursing leadership in the Advancing Excellence Campaign: moving interdisciplinary collaboration forward.

Nursing was not a part of the coalition of multiple nursing home stakeholders at the roll out of the Advancing Excellence Campaign (AEC). In January 2007, several nurse organizations proactively approached the AEC leadership, were welcomed and immediately began to volunteer for leadership positions such as committee chairs and conference coordinators. This paper presents an exemplar of how a proactive stance, even when not initially included, allowed nurses to secure chairs at the decision making table of this quality campaign and contribute to improved resident outcomes.

Nurse competencies for person-directed care in nursing homes.

A national movement to transform U.S. nursing homes is occurring with the intent to support self-determination, dignity and choice for nursing home residents facilitated by the continuation of their routines and preferences. Ten competencies for nurses were identified to facilitate this culture change in nursing homes. These competencies are intended to: model resident-directed care; foster effective team work with direct care workers to solve problems and make decisions that support residents; and promote a positive work and home environment. The strategies used to identify and disseminate the ten competencies are described as well as implications of the competencies for practice, education, and research.

Aging issues: nursing imperatives for healthcare reform.

The people of the United States sent a clear message in November 2008 that they wanted a change in the nation's priorities, including healthcare. The question is whether healthcare reform will extend to the care of older adults, especially in the face of complex needs in the last years of their lives. This article addresses this question by examining the demographics of the older adult population, the eldercare workforce, and the current inadequate patchwork of financing. Some aging issues, such as chronic care, are being addressed in the broad context of healthcare reform, whereas health information technology and others remain marginal. The window of opportunity for a clear and coherent voice in a reformed/reshaped healthcare system is narrow. Now is the time for the "trusted" profession to advocate for meaningful change that will meet the current and future needs of older adults. The article concludes with strategies and Web-based resources for nurses to bring aging issues to the healthcare reform debate at both the national and local levels.

Expanding the knowledge base of resident and facility outcomes of care delivered by advanced practice nurses in long-term care: expert panel recommendations.

In 2003, a panel of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care convened to examine and make recommendations about care quality and safety issues related to advanced practice nurses (APNs) in nursing home practice. This article reports on the panel recommendation that addressed expanding the evidence base of resident and facility outcomes of APN nursing home practice. A review of the small but important body of research related to nursing home APN practice suggests a positive impact on resident care and facility outcomes. Recommendations are made for critically needed research in four key areas: (a) APN nursing home practice, (b) relative value unit coding, (c) outcomes related to geropsychiatric and mental health nursing services, and (d) outcomes related to geriatric specialization. The APN role could be significantly enhanced and executed if its specific contribution to resident and facility outcomes was more clearly delineated through the recommended rigorous research.

Nursing homes as a clinical site for training geriatric health care professionals.

Nursing homes can be ideal clinical teaching and learning environments for acquiring geriatric specialty and interdisciplinary team skills, particularly those regarding assessment, care planning, management, monitoring, and collaborating in an interdisciplinary milieu. Little is known as to how geriatric specialty training programs use nursing homes to meet expected specialty competencies, or the types of clinical experiences in nursing homes required by academic geriatric training programs. This article describes the expectations of 5 clinical health care disciplines (dentistry, medicine, nursing, pharmacy, and social work) and nursing home administration regarding desirable nursing home characteristics that support gaining geriatric competencies. The issues involved in using nursing homes as supportive educational environments in geriatric education are discussed.

Healthcare professional training: a comparison of geriatric competencies.

Health professionals specializing in geriatrics are a unique but scarce resource who nevertheless play a critical role in shaping the care of older adults. An interdisciplinary didactic and clinical training milieu would have the potential to maximize training opportunities for geriatric healthcare professionals. The fact that little is known about the concordance between discipline-specific geriatric competencies hampers the creation of interdisciplinary geriatric training opportunities. Discipline-specific geriatric experts compared the geriatric competencies specified by geriatric-certifying bodies of five healthcare professions: dentistry, medicine, nursing, pharmacy, and social work. Overlap and differences in geriatric competencies across disciplines are presented, and opportunities and barriers to interdisciplinary geriatric education are discussed.

Rethinking teaching nursing homes: potential for improving long-term care.

To meet the special needs of and provide quality health care to nursing home residents, the health care workforce must be knowledgeable about the aging process. Health professionals are minimally prepared in their academic programs to care for older adults, and few programs have required rotations in geriatrics. Teaching nursing homes (TNHs) have shown promise as sites for the preparation of a health workforce to care for older adults in nursing homes as well as improvement of quality outcomes. This article reports on the process and recommendations of a TNH summit of experts in geriatric education and practice as to the feasibility of developing a sustainable and replicable TNH model that would prepare a professional workforce knowledgeable about and prepared to work in long-term care. The TNH summit identified characteristics of partnerships between academia, nursing home(s), and other stakeholders that would constitute a successful TNH collaboration. Goals of a TNH partnership between service and academia include interdisciplinary education and practice, research and dissemination of evidence-based practices, and benchmarks of a nursing home professional learning environment.

Elevated microsatellite instability at selected tetranucleotide repeats does not correlate with clinicopathologic features of bladder cancer.

INTRODUCTION: The aim of the present study was to evaluate whether elevated microsatellite instability (MSI) at selected tetranucleotide repeats (EMAST) is associated with clinicopathologic and molecular parameters in urinary bladder cancer (BC). METHODS: A consecutive series of 117 nonselected urothelial BCs was studied. Microsatellite analysis and detection of loss of heterozygosity (LOH) was performed after microdissection by using 12 markers selected for sensitive detection of EMAST. Furthermore, five markers (BAT25, BAT26, D2S123, APC, and D17S250) of the Bethesda consensus panel for detection of colorectal cancer within the hereditary non-polyposis colon cancer syndrome (HNPCC) were analyzed. Expression of TP53 and mismatch repair (MMR) proteins hMSH2, hMLH1, and hMSH6 was investigated by immunohistochemistry. RESULTS: EMAST was detected in 10 of 117 patients (8.5%), whereas MSI in the HNPCC panel was found in one of 114 cases (0.9%). LOH in EMAST markers was seen in six of 114 (5.3%) cases. All tumours showed normal expression of hMSH2 and hMLH1. Overexpression of TP53 was observed in nine of 117 evaluated cases (7.7%). No association of EMAST and TP53 expression could be demonstrated. None of the clinicopathologic or molecular parameters were associated with EMAST. CONCLUSIONS: EMAST is another distinct form of MSI in urothelial BC. However, EMAST seems to be a rare event in non-selected urothelial BC and does not seem to be associated with commonly used clinicopathologic and clinical features in patients with BC.

Experts recommend strategies for strengthening the use of advanced practice nurses in nursing homes.

In 2003, The John A. Hartford Foundation Institute for Geriatric Nursing, New York University Division of Nursing, convened an expert panel to explore the potential for developing recommendations for the caseloads of advanced practice nurses (APNs) in nursing homes and to provide substantive and detailed strategies to strengthen the use of APNs in nursing homes. The panel, consisting of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care, developed six recommendations related to caseloads for APNs in nursing homes. The recommendations address educational preparation of APNs; average reimbursable APN visits per day; factors affecting APNs caseload parameters, including provider characteristics, practice models, resident acuity, and facility factors; changes in Medicare reimbursement to acknowledge nonbillable time spent in resident care; and technical assistance to promote a climate conducive to APN practice in nursing homes. Detailed research findings and clinical expertise underpin each recommendation. These recommendations provide practitioners, payers, regulators, and consumers with a rationale and details of current advanced practice nursing models and caseload parameters, preferred geriatric education, reimbursement strategies, and a range of technical assistance necessary to strengthen, enhance, and increase APNs' participation in the care of nursing home residents.