The American Academy of Nursing 50th Anniversary of the Nursing Theory Guided Practice Expert Panel (NTGPEP): Exploring the Past-Re-envisioning the Future

The Nursing Theory-Guided Practice Expert Panel (NTGP-EP), one of the 14 Expert Panels, is officially designated to advance the mission and strategic goals of the American Academy of Nursing. The NTGP-EP has created a forum for dialogue among nurse scholars interested in advancing nursing theory to promote health and wellbecoming. The purpose of this paper is to share the important work of the NTGP-EP and its history, contributions, and accomplishments, and to propose a member-driven agenda to re-envision our preferred future and the impact of the use of nursing theory to guide nursing education, research, practice, and policy.

A fish-like soft-robotic model generates a diversity of swimming patterns

Fish display a versatile array of swimming patterns, and frequently demonstrate the ability to switch between these patterns altering kinematics as necessary. Many hard and soft robotic systems have sought to understand a variety of aspects pertaining to undulatory swimming, but most have been built to focus solely on a subset of those swimming patterns. We have expanded upon a previous soft robotic model, the pneufish, so that it can now simulate a variety of swimming patterns, much like a real fish. We explore the performance space available for this longer soft robotic model, which we call the quad-pneufish, with particular attention to the effects on lateral forces and z-torques produced during locomotion. We show that the quad-pneufish is capable of achieving a variety of midline patterns - including more realistic, fish-like patterns - and introducing a slight amount of co-activation between the left and right sides maintains forward thrust while decreasing lateral forces, indicating an increase in swimming efficiency. Robotic systems that are capable of producing an array of swimming movement patterns hold promise as experimental platforms for studying the diversity of fish locomotor patterns.

Fish-like aquatic propulsion studied using a pneumatically-actuated soft-robotic model

Fish locomotion is characterized by waves of muscle electrical activity that proceed from head to tail, and result in an undulatory pattern of body bending that generates thrust during locomotion. Isolating the effects of parameters like body stiffness, co-activation between the right and left sides of the body, and frequency on thrust generation has proven to be difficult in live fishes. We use a pneumatically-actuated fish-like model to investigate how these parameters affect locomotor force generation. We measure thrust as well as side forces and torques generated during propulsion. Using a statistical linear model we examine the effects of input parameter combinations on thrust generation. We show that both stiffness and frequency substantially affect swimming kinematics, and that there are complex interactive effects of these two parameters on thrust. The stiffer the backbone the more impact that increasing frequency has on thrust production. For stiffer models, increasing frequency resulted in higher values for both thrust and lateral forces. Large side forces reduce swimming efficiency but this effect could be mitigated by decreasing undulatory wavelength and allowing appropriate phasing of left and right body movements to reduce amplitudes of side force.

Peak and baseline concentrations of fondaparinux during prophylactic therapy

Fondaparinux is widely approved for prophylaxis and treatment of venous thromboembolic events (VTE). However, its longer half-life time compared to heparins limits its peri-procedural use.

Aim: To investigate 3h peak and 24h baseline concentrations of fondaparinux when administered for prophylaxis (1 x 2.5 mg qd). Secondary outcome measures: incidences of VTE, bleedings, HIT, allergic skin reactions, 30 days mortality.

Patients, methods: Between 02/2010 and 03/2011, 3h peak and 24h baseline levels of fondaparinux were measured with a chromogenic anti-FXa method in 75 consecutive patients. Medical data were obtained from patients' records.

Results: The 5% and 95% percentile of the 3h peak level were 0.20 μg/ml and 0.83 μg/ml (median: 0.53 μg/ml), and of the 24h baseline level 0.08 μg/ml and 0.53 μg/ml (median 0.21 μg/ml), respectively. An inverse correlation was found between fondaparinux levels and GFRs (rho=-0.617 (3h); rho=-0.648 (24h); p=0.01). Shorter (≤5 days) or longer (≥8 days) duration of prior fondaparinux exposure showed no significantly different 3h peak/24h baseline levels (p>0.6). One progressive thrombosis occurred but no major bleedings, HIT, allergic skin reactions or fatalities.

Conclusions: After fondaparinux exposure, >75% of the patients still had relevant prophylactic 24h baseline levels. This did not coincide with a high rate of bleeding events. Due to the low patient number in this study undergoing surgery or interventions, it remains to be investigated whether or at which concentrations the bleeding risk is increased when baseline levels are within prophylactic ranges.

Fortschritte in der Thrombozytenfunktionsdiagnostik

Both for diagnosis of congenital and acquired platelet dysfunction as well as for therapy monitoring after application of platelet function inhibitors various methods have been established for evaluation of platelet function. In contrast to the gold standard of platelet function testing, the light transmission aggregometry in platelet rich plasma the Point-of-care (POC) analyzers allow fast analysis of platelet function without extensive laboratory work up. The conditions of the pre-analytical phase, however, are still of enormous importance in the prevention of medical errors. There is increasing clinical data in monitoring the effect of platelet aggregation inhibitors, showing that quantitative determination of the platelet function degree correlates with risk of increased bleeding or stent thrombosis. However, it is still unclear, which is the optimal test system, to predict the clinical outcome of these patients.

Effectiveness of standard of care protocol on patient satisfaction and perceived staff caring

BACKGROUND

Nurse caring has been linked to many clinical outcomes, including patient satisfaction, well-being, and healing. In addition, it is valued by nursing staff and viewed as being essential to clinical practice.

OBJECTIVES

The purpose of this program evaluation study was to determine the difference in patient satisfaction with overall nursing care and perceived nurse caring when a nursing staff standard of care protocol, which included caring activities, was implemented within a nursing department at a National Cancer Institute-designated comprehensive cancer center.

METHODS

A pre-experimental pre-/post-test design with comparison group and a post-test-only design were used to test the effect of the caring protocol on patient satisfaction with nursing care and perceived nurse caring. The study was conducted on seven inpatient units.

FINDINGS

Patient satisfaction with nursing care increased for some items, and perceived nurse caring was ranked highly immediately before discharge. Additional program evaluation studies involving a modified caring protocol may improve satisfaction with nursing care in other settings.

Expanded dog leukocyte antigen (DLA) single nucleotide polymorphism (SNP) genotyping reveals spurious class II associations

The dog leukocyte antigen (DLA) system contains many of the functional genes of the immune system, thereby making it a candidate region for involvement in immune-mediated disorders. A number of studies have identified associations between specific DLA class II haplotypes and canine immune hemolytic anemia, thyroiditis, immune polyarthritis, type I diabetes mellitus, hypoadrenocorticism, systemic lupus erythematosus-related disease complex, necrotizing meningoencephalitis (NME) and anal furunculosis. These studies have relied on sequencing approximately 300 bases of exon 2 of each of the DLA class II genes: DLA-DRB1, DLA-DQA1 and DLA-DQB1. In the present study, an association (odds ratio=4.29) was identified by this method between Weimaraner dogs with hypertrophic osteodystrophy (HOD) and DLA-DRB1∗01501. To fine map the association with HOD, a genotyping assay of 126 coding single nucleotide polymorphisms (SNPs) from across the entire DLA, spanning a region of 2.5 Mb (3,320,000-5,830,000) on CFA12, was developed and tested on Weimaraners with HOD, as well as two additional breeds with diseases associated with DLA class II: Nova Scotia duck tolling retrievers with hypoadrenocorticism and Pug dogs with NME. No significant associations were found between Weimaraners with HOD or Nova Scotia duck tolling retrievers with hypoadrenocorticism and SNPs spanning the DLA region. In contrast, significant associations were found with NME in Pug dogs, although the associated region extended beyond the class II genes. By including a larger number of genes from a larger genomic region, a SNP genotyping assay was generated that provides coverage of the extended DLA region and may be useful in identifying and fine mapping DLA associations in dogs.

[Progress in diagnostic evaluation of platelet function disorders]

Both for diagnosis of congenital and acquired platelet dysfunction as well as for therapy monitoring after application of platelet function inhibitors various methods have been established for evaluation of platelet function. In contrast to the gold standard of platelet function testing, the light transmission aggregometry in platelet rich plasma the Point-of-care (POC) analyzers allow fast analysis of platelet function without extensive laboratory work up. The conditions of the pre-analytical phase, however, are still of enormous importance in the prevention of medical errors. There is increasing clinical data in monitoring the effect of platelet aggregation inhibitors, showing that quantitative determination of the platelet function degree correlates with risk of increased bleeding or stent thrombosis. However, it is still unclear, which is the optimal test system, to predict the clinical outcome of these patients.