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Nursing research is an integral part of nursing science and essential for evidence-based nursing practice. Research conducted by nursing scientists employed at university hospitals is shaped by the specific prevailing conditions. It is largely unclear to what extent these nursing scientists are engaged in research and which difficulties they have to face. The purpose of the study was to gain insight into nursing scientists’ research activities in German university hospitals and to assess the challenges they encounter in gaining ethical approval from institutional review boards.

Shortage in nursing resource results from the combination of a lack of nurses, an increased patient volume and workload, and other factors. This seems to be a worldwide phenomenon, leading to multiple health care related challenges and a decreased quality of care, but is different in extent in high- vs. low-income countries. An international perspective can alleviate challenges to keep our patients safe through increasing our health workers' safety.

Sie sind eine tragende Säule der gesundheitlichen Versorgung der Bevölkerung, unterstützen vulnerable Gruppen, bieten psychosoziale Unterstützung und tragen zur wirtschaftlichen Entwicklung bei. Dennoch scheint Berufsstolz in der Pflege in Deutschland kaum ausgebildet zu sein. Das Netzwerk Pflegewissenschaft und Praxisentwicklung im VPU nähert sich dem Thema zusammen mit Studierenden der Pflege. "Das haben wir geschafft"! Konzepte und unterschiedliche Zugänge zum Thema Berufsstolz - mit teils überraschenden Ergebnissen. Die vorgestellten Qualifikationsarbeiten geben einen Einblick in die Bandbreite und Vielschichtigkeit des Themas Berufsstolz in der Pflege.

Pflegeexpert*innenrollen APN belegen weltweit ihre positiven Auswirkungen auf exzellente Versorgungsergebnisse wie auch die Gestaltung positiver Arbeitsbedingungen. National sind diese erweiterten und vertieften Pflegerollen nach wie vor nur vereinzelt anzutreffen. Die Expert*innengruppe Erweiterte Pflegepraxis des Deutschen Berufsverband für Pflegeberufe (DBfK) hat zur Förderung von APN-Rollen eine orientierende Vorlage für ein Anforderungs- und Tätigkeitsprofil für Pflegeexpert*innen APN entwickelt. Dieser Beitrag beschreibt mögliche Kompromisse und Übergangslösungen in der Implementierung und Rollenentwicklung, immer verbunden mit dem Ziel, eine internationale Annäherung und Vergleichbarkeit zu erreichen.

It is unclear whether patients with asthma benefit from stepping up to high-dose inhaled corticosteroids (ICSs).

BackgroundMaintenance and reliever therapy (MART) with inhaled corticosteroid (ICS)/formoterol effectively reduces exacerbations in asthma. We aimed to investigate its efficacy compared with fixed-dose fluticasone/salmeterol in chronic obstructive pulmonary disease (COPD).MethodsPatients with COPD and ≥1 exacerbation in the previous 2 years were randomly assigned to open-label MART (Spiromax budesonide/formoterol 160/4.5 µg 2 inhalations twice daily+1 prn) or fixed-dose therapy (Diskus fluticasone propionate/salmeterol combination (FSC) 500/50 µg 1 inhalation twice daily+salbutamol 100 µg prn) for 1 year. The primary outcome was rate of moderate/severe exacerbations, defined by treatment with oral prednisolone and/or antibiotics.ResultsIn total, 195 patients were randomised (MART Bud/Form n=103; fixed-dose FSC n=92). No significant difference was seen between MART and FSC therapy in exacerbation rates (1.32 vs 1.32 /year, respectively, rate ratio 1.05 (95% CI 0.79 to 1.39); p=0.741). No differences in lung function parameters or health status were observed. Total ICS dose was significantly lower with MART than FSC therapy (budesonide-equivalent 928 µg/day vs 1747 µg/day, respectively, p<0.05). Similar proportions of patients reported adverse events (MART Bud/Form: 73% vs fixed-dose FSC: 68%, p=0.408) and pneumonias (MART: 5% vs FSC: 1%, p=0.216).ConclusionsThis first study of MART in COPD found that budesonide/formoterol MART might be similarly effective to fluticasone/salmeterol fixed-dose therapy in moderate to severe patients with COPD, at a lower daily ICS dosage. Further evidence is needed about long-term safety.

Acute kidney injury (AKI) is a major health issue, the outcome of which depends primarily on damage and reparative processes of tubular epithelial cells. Mechanisms underlying AKI remain incompletely understood, specific therapies are lacking and monitoring the course of AKI in clinical routine is confined to measuring urine output and plasma levels of filtration markers. Here we demonstrate feasibility and potential of a novel approach to assess the cellular and molecular dynamics of AKI by establishing a robust urine-to-single cell RNA sequencing (scRNAseq) pipeline for excreted kidney cells via flow cytometry sorting. We analyzed 42,608 single cell transcriptomes of 40 urine samples from 32 patients with AKI and compared our data with reference material from human AKI post-mortem biopsies and published mouse data. We demonstrate that tubular epithelial cells transcriptomes mirror kidney pathology and reflect distinct injury and repair processes, including oxidative stress, inflammation, and tissue rearrangement. We also describe an AKI-specific abundant urinary excretion of adaptive progenitor-like cells. Thus, single cell transcriptomics of kidney cells excreted in urine provides noninvasive, unprecedented insight into cellular processes underlying AKI, thereby opening novel opportunities for target identification, AKI sub-categorization, and monitoring of natural disease course and interventions.

Introduction: Dry powder inhalers (DPIs), a commonly prescribed inhaler type for respiratory diseases, require patients to generate sufficient peak inspiratory flow (PIF) to ensure optimal drug delivery to the airways. Effectiveness of therapy also requires a good inhalation technique and adequate medication adherence. For patients with chronic obstructive pulmonary disease (COPD), recent studies conducted in tertiary care suggest that DPI users with suboptimal PIF have poorer COPD-related health status and increased exacerbation risk versus those with optimal PIF. The PIFotal study will investigate the impact of PIF, inhalation technique and medication adherence on patient-reported outcomes in patients with COPD in primary care using a DPI for their maintenance therapy. Methods and Analysis: This cross-sectional observational study will assess 1200 patients (aged ≥ 40 years, diagnosed with COPD and using a DPI for COPD maintenance therapy for ≥ 3 months) from the Netherlands, Spain, Portugal, Poland, Greece and Australia. Assessments will consist of (1) PIF measurements (usual patient inhalation manoeuvre, maximal PIF against resistance of own inhaler, and maximal PIF against low resistance); (2) Clinical COPD Questionnaire (CCQ), COPD Assessment Test and Test of Adherence to Inhalers scores; and (3) video recordings of patient inhalation technique. Dependent variables include health status (CCQ score), number of self-reported exacerbations in previous 12 months, and healthcare resource utilisation in previous 6 months. Independent variables include PIF values, inhalation technique errors, medication adherence, and demographic and clinical characteristics. In the primary analysis, the mean difference in CCQ score between patients (1) with optimal/suboptimal PIF, (2) exhibiting/not exhibiting inhalation technique errors, and (3) adhering/not adhering to medication will be examined in a multivariable linear mixed model. Ethics: The study protocol was approved by ethics committees/institutional review boards of all participating sites prior to enrolment; written informed consent was obtained from all study participants. Trial Registration Number: ClinicalTrials.gov: NCT04532853.

The management of medication nonadherence of patients with asthma or chronic obstructive pulmonary disease (COPD) remains challenging. Given the multitude of underlying causes, a personalized approach is required. The Test of Adherence to Inhalers (TAI) can identify reasons for nonadherence, but it does not provide guidance regarding how to act effectively after results.

Der Wissenschaftsrat fordert, dass die Universitätsmedizinstandorte Deutschlands ihre Aufgaben- und Kompetenztrias um eine vierte Säule, die System- und Zukunftsaufgaben, erweitern. Die Profession Pflege, als bestehender und zentraler Bestandteil der Versorgung in Universitätskliniken (UK) sieht sich für diese neuen Aufgaben ebenfalls in der Verantwortung. Pflegefachpersonen integrieren Koordinierungs- und Steuerungsfunktionen, die auch über die stationäre Versorgung hinauswirken, bereits seit langem in ihrem Klinikalltag. Was die Forderung für Pflegefachpersonen an den UK in Deutschland konkret bedeutet und welche Potenziale mit dieser möglichen Entwicklung verbunden sind führen der Verband der Pflegedirektor*innen der Universitätskliniken und Medizinischen Hochschulen (VPU) e.V. und dessen Netzwerk Pflegewissenschaft und Praxisentwicklung im vorliegenden Artikel aus.

Pflegefachpersonen mit Hochschulabschluss werden zunehmend in Universitätskliniken in Deutschland beschäftigt. Unklar ist, wie sie eingruppiert und vergütet werden. Das Netzwerk Pflegewissenschaft und Praxisentwicklung im VPU führte daher 2020 eine diesbezügliche Befragung aller 40 Pflegedirektor*innen der Universitätskliniken durch. Im Ergebnis zeigt sich, dass der Anteil akademisierter Pflegefachpersonen an den Universitätskliniken mit <5% sehr gering ist. Wenn vorhanden, liegen Stellenbeschreibungen eher für akademisierte Pflegefachpersonen in Bereichen der nicht direkten Pflege als in der direkten Patient*innenversorgung vor. In allen akademischen Graden erfolgt bundesweit eine heterogene Bezahlung mit teilweise >100% Variabilität. Eine Diskussion zur Eingruppierung und Vergütung akademisierter Pflegefachpersonen sollte (fort-)geführt werden.

Dem Pflegemanagement kommt eine tragende Rolle bei der Bewältigung von pandemiebedingten Herausforderungen im Gesundheitswesen zu. Dabei erfordert die Pandemie eine stetige Anpassung an eine volatile Situation. Pflegende - und in besonderem Maße das Pflegemanagement - gestalten diesen Prozess. Eine Onlinebefragung des Netzwerks Pflegewissenschaft und Praxisentwicklung im Verband der Pflegedirektorinnen und Pflegedirektoren der Universitätskliniken und Medizinischen Hochschulen Deutschlands e.V. (VPU) in Zusammenarbeit mit dem Bundesverband Pflegemanagement e.V. verdeutlicht die Leistungen und die Erfahrungen des Pflegemanagements in der Pandemie, weist auf die Auswirkungen auf das Arbeitsfeld und die Tätigkeiten der Pflegemanager*innen hin und ermöglicht es, Empfehlungen für den Fall zukünftiger Pandemien abzuleiten.

Severe congenital neutropenia (SCN) is a monogenic disorder. SCN patients are prone to recurrent life-threatening infections. The main causes of SCN are autosomal dominant mutations in the ELANEgene that lead to a block in neutrophil differentiation. In this study, we use CRISPR-Cas9 ribonucleoproteins and adeno-associated virus (AAV)6 as a donor template delivery system to repair the ELANEL172Pmutation in SCN patient-derived hematopoietic stem and progenitor cells (HSPCs). We used a single guide RNA (sgRNA) specifically targeting the mutant allele, and an sgRNA targeting exon 4 of ELANE. Using the latter sgRNA, ∼34% of the known ELANEmutations can in principle be repaired. We achieved gene correction efficiencies of up to 40% (with sgELANE-ex4) and 56% (with sgELANE-L172P) in the SCN patient-derived HSPCs. Gene repair restored neutrophil differentiation in vitroand in vivoupon HSPC transplantation into humanized mice. Mature edited neutrophils expressed normal elastase levels and behaved normally in functional assays. Thus, we provide a proof of principle for using CRISPR-Cas9 to correct ELANEmutations in patient-derived HSPCs, which may translate into gene therapy for SCN.

BackgroundLittle is known about the impact of exacerbations on COPD progression or whether inhaled corticosteroid (ICS) use and blood eosinophil count (BEC) affect progression. We aimed to assess this in a prospective observational study.MethodsThe study population included patients with mild to moderate COPD, aged ≥35 years, with a smoking history, who were followed up for ≥3 years from first to last spirometry recording using two large UK electronic medical record databases: Clinical Practice Research Datalink (CPRD) and Optimum Patient Care Research Database (OPCRD). Multilevel mixed-effects linear regression models were used to determine the relationship between annual exacerbation rate following initiation of therapy (ICS vs non-ICS) and FEV1decline. Effect modification by blood eosinophils was studied through interaction terms.ResultsOf 12178 patients included (mean age 66 years; 48% female), 8981 (74%) received ICS. In patients with BEC ≥350 cells/µL not on ICS, each exacerbation was associated with subsequent acceleration of FEV1decline of 19.4 mL/year (95% CI 12.0 to 26.7, p<0.0001). This excess decline was reduced by 15.1 mL/year (6.6 to 23.6) to 4.3 mL/year (1.9 to 6.7, p<0.0001) in those with BEC ≥350 cells/µL treated with ICS.ConclusionExacerbations are associated with a more rapid loss of lung function among COPD patients with elevated blood eosinophils, defined as ≥350 cells/µL, not treated with ICS. More aggressive prevention of exacerbations using ICS in such patients may prevent excess loss of lung function.

Im pflegerischen Berufsalltag kommt es immer wieder zu Situationen, die Unsicherheit hervorrufen, Fragen aufwerfen oder mit Belastungen verbunden sind. Häufig müssen solche Herausforderungen allein bewältigt werden, obwohl gerade der Pflegeberuf in vielen Fällen eine Arbeit in Teams bedeutet. Rat oder Unterstützung bei Kollegen zu suchen, erfolgt - wenn überhaupt - zumeist eher beiläufig in Form von "Zwischen-Tür-und-Angel-Gesprächen" oder Randgesprächen bei der Schichtübergabe. Vielfach bleibt die bewusste Ratsuche jedoch aus oder wird in den privaten Bereich ver- lagert, dabei verfügen die Kollegen über einen reichen Schatz an Erfahrungen und erworbenem Wissen. Kollegiale Beratung hilft, dieses Wissen strukturiert und zielorientiert in einen Austausch zu bringen.

In this study, Labi et al. examined the role of miRNAs in suppressing apoptosis by targeting miRNA-17~92 involved in regulating the pro-apoptotic protein BIM. Through conditional seed match mutagenesis the authors show that blocking miR-17~92:Bim interaction early in development phenocopied the lethal lung phenotype, produced a selective inability of B cells to resist cellular stress, and prevented B and T cell hyperplasia caused by Bim haploinsufficiency.

Digital inhalers can monitor inhaler usage, support difficult-to-treat asthma management, and inform step-up treatment decisions yet their economic value is unknown, hampering wide-scale implementation.

Supplemental Digital Content is available in the text

Uit een kwalitatief focusgroeponderzoek onder 29 patiënten met astma of COPD bleek dat sociale problemen veel invloed hebben op het leven van deze patiënten. De huidige behandelingsrichtlijnen hebben hiervoor geen tot weinig aandacht. In dit artikel geven we tips en suggesties van onze focusgroeppatiënten en uit de literatuur.

Herpesviruses can infect a wide range of animal species. Herpes simplex virus 1 (HSV-1) is one of the eight herpesviruses that can infect humans and is prevalent worldwide. Herpesviruses have evolved multiple ways to adapt the infected cells to their needs, but knowledge about these transcriptional and post-transcriptional modifications is sparse. Here, we show that HSV-1 induces the expression of about 1000 antisense transcripts from the human host cell genome. A subset of these is also activated by the closely related varicella zoster virus. Antisense transcripts originate either at gene promoters or within the gene body, and they show different susceptibility to the inhibition of early and immediate early viral gene expression. Overexpression of the major viral transcription factor ICP4 is sufficient to turn on a subset of antisense transcripts. Histone marks around transcription start sites of HSV-1-induced and constitutively transcribed antisense transcripts are highly similar, indicating that the genetic loci are already poised to transcribe these novel RNAs. Furthermore, an antisense transcript overlapping with the BBC3 gene (also known as PUMA) transcriptionally silences this potent inducer of apoptosis in cis. We show for the first time that a virus induces widespread antisense transcription of the host cell genome. We provide evidence that HSV-1 uses this to downregulate a strong inducer of apoptosis. Our findings open new perspectives on global and specific alterations of host cell transcription by viruses.

Mit dem Ziel, die Pflege — analog der Hochschulmedizin — auf eine breite wissenschaftliche Basis zu stellen, die Verflechtung von Lehre, Forschung und Krankenversorgung zu stärken und pflegebezogene Forschungsaktivitäten an Universitätskliniken zu bündeln, initiierte der VPU 2010 das Netzwerk Pflegeforschung. Zu den Zielen des Netzwerks zählen der kollegiale Austausch und die gegenseitige Unterstützung, die gemeinsame Etablierung, Weiterentwicklung und Erweiterung der Pflegepraxis sowie die Entwicklung von gemeinsamen Forschungsprojekten und die Einwerbung von Drittmitteln.

AbstractBackground:While the impact of COPD in Western-Europe is known, data from Eastern-Europe is scarce. This study aimed to evaluate clinical characteristics, treatment patterns, and the socio-economic burden of COPD in Eastern-Europe, taking Bulgaria as a reference case.Methods:A representative sample of Bulgarian patients with COPD was randomly chosen by pulmonologists, based on the following inclusion criteria: COPD diagnosis with at least 1 year of living with COPD, ≥40 years of age, and use of COPD medication. Patient characteristics, treatment, quality-of-life, healthcare resource use, and costs were systematically assessed.Results:A total of 426 COPD patients were enrolled. Approximately 69% were male, 40% had occupational risk factors, 45% had severe and 11% had very severe COPD. Mean CAT scores were 13.80 (GOLD A), 21.80 (GOLD B), 17.35 (GOLD C), and 26.70 (GOLD D). Annual per-patient costs of healthcare utilization were €579. Yearly pharmacotherapy costs were €693. Indirect costs (reduced and lost work productivity) outnumbered direct costs three times.Conclusions:Bulgaria has relatively high percentages of (very) severe COPD patients, resulting in considerable socio-economic burden. High smoking rates, occupational risk factors, air pollution, and a differential health system may be related to this finding. Eastern-European COPD strategies should focus on prevention, risk-factor awareness, and early detection.

A poor inhaler technique continues to represent a substantial barrier to effective asthma and chronic obstructive pulmonary disease management. It can result in perceived lack of treatment effectiveness even with apparent adherence to a prescribed regimen of inhaled maintenance therapies, potentially resulting in an unnecessary change or escalation of treatment. Many patients are not trained to inhaler mastery in real-world practice; furthermore, even where mastery is initially achieved, an ongoing assessment and education are seldom maintained. In this review, we present an overview of the evidence for deterioration of the inhaler technique over time after training, investigate the factors that contribute to this deterioration, and explore innovative approaches to addressing the problem. We also propose steps forward drawn from the literature and our clinical insights.

The differential diagnosis of asthma and chronic obstructive pulmonary disease (COPD) poses a challenge in clinical practice and its misdiagnosis results in inappropriate treatment, increased exacerbations, and potentially death.

Um dem Anforderungswandel in der komplexer werdenden Patientenversorgung zukünftig gerecht werden zu können, wird eine stärkere Differenzierung der Pflegepersonalstruktur, insbesondere die Einbindung hochschulisch qualifizierter Pflegefachpersonen empfohlen. Dies ist internationaler Standard und wird vom deutschen Wissenschaftsrat empfohlen. Unklar ist der aktuelle Umsetzungsgrad der Empfehlungen in deutschen Universitätskliniken. Die Untersuchung ermittelt den Anteil hochschulisch qualifizierter Pflegefachpersonen und deren Tätigkeitsprofil an deutschen Universitätskliniken.