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Background: Artwork can be used to practice the development of holistic care for nursing students. This activity was designed for senior nursing students to develop their holistic nursing skills through a series of in-class activities while viewing Frida Kahlo's The Broken Column . Aim: This study's aim was to design an educational experience to develop a more holistic approach to caring for patients for nursing students. Method: Students submitted their initial impressions of the painting via an anonymous quiz. After a guided Visual Thinking Strategies (VTS) session, students submitted impressions of the artwork. A VTS facilitator read a history of an accident which revealed the cause of Kahlo's medical and emotional pain. Students then wrote about their perceptions of the painting's meaning and how they might use VTS in caring for their patients. Answers were analyzed using Braun and Clark's thematic analysis. Results: The themes identified were emotions and feelings, metaphor, life/story, and listening to inform perspective. Most found that VTS changed their impressions and enhanced their ability to question patients and inform their care. Conclusion: Students found that VTS expanded their view of patient care and helped them see the patient more holistically, aligning with the development of clinical judgment.

Background: Many nursing faculty lack formal training in item writing and test construction., Purpose: This integrative review synthesizes the evidence to gain a comprehensive understanding of the developmental needs and interventions employed to help nursing faculty gain skills to develop course examinations., Methods: Original research and non-research reports published since 2012 were included. Independent quality appraisals were completed based on the Johns Hopkins Nursing Evidence-based Practice Model. Data were analyzed using the constant comparison method., Results: Nineteen reports met inclusion criteria. Themes related to test development skills were standards support practice, educational preparation, evolving technologies, and writing for clarity. Themes related to faculty development were continuous improvement, professional development plans, peer and expert collaboration, and up-to-date resources., Conclusions: Nursing programs need to establish methods to ensure faculty use best practices and are competent in test development. Nursing needs future research to understand optimal faculty development approaches., Competing Interests: Disclosures : The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Objective: To examine the efficacy, safety, and long-term durability of the autologous pubovaginal sling for stress incontinence over a 29-year period., Methods: A total of 192 consecutive female patients with stress urinary incontinence who underwent autologous pubovaginal sling from 1993 through 1999 were analyzed over a 29-year period. Intermediate and ultra long-term follow-up were obtained at a mean of 4 and 23 years, respectively. A total of 51 patients had sufficient data at both time intervals and were evaluated using a standardized questionnaire for resolution of stress incontinence, the primary endpoint, as well as resolution of urge incontinence, overall dryness, and voiding dysfunction., Results: At intermediate-term follow-up (mean 45.3 months), 96% of 51 patients reported no stress incontinence. In addition, 76% of patients experienced resolution of their preoperative urge incontinence. Overall dryness occurred in 84%. At ultra long-term follow-up (mean 22.9 years), 84% reported no stress incontinence and an overall dryness rate of 53%. Postoperative voiding dysfunction included de novo urge incontinence (3 patients) and persistent urinary obstruction requiring urethrolysis (1 patient)., Conclusion: The autologous pubovaginal sling is effective, safe, and durable at a mean of 23 years, the longest known follow-up in the literature. Given the U.S. Food and Drug Administration (FDA) warnings regarding transvaginal mesh and growing concerns with the synthetic midurethral sling, the autologous pubovaginal sling should be offered as an option to those women seeking treatment for stress urinary incontinence., Competing Interests: Declaration of Competing Interest All authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Visual Thinking Strategies is a teaching technique initially studied in primary education but recently has been used to teach nursing students and other healthcare professionals. VTS has been found to help participants think and see differently, explore learning in safe environments, and develop ethical competencies. Experiences with VTS can create rich discussions and present opportunities for nurses to talk about issues and concerns that may not always present in the classroom. VTS can provide participants with the ability to explore meanings and engage in conversations about diversity and social determinants of health. This article explores how teachers can use VTS to create meaningful dialogue with participants and relate it to their care of patients.

Introduction: In recent years, there has been significant growth of ambulatory oncology pharmacy, yet there is a paucity of published studies on the clinical activities and impact of ambulatory oncology clinical pharmacists. At Duke Cancer Center, dedicated pharmacist services are embedded in specialized outpatient oncology areas. Pharmacists document their clinical and administrative activities in the electronic health record. The primary objective of this study is to quantify and assess ambulatory oncology pharmacist interventions in clinics in a large academic comprehensive cancer center., Methods: For the purposes of this single-center, retrospective, descriptive study, pharmacist interventions were collected, quantified, and described over a 6-month period from July 1 to December 31, 2015. The study evaluated the perceived contribution and impact of a pharmacist on patient care in ambulatory oncology clinics via a survey that was distributed to providers and nurses., Results: In the 6-month time period, there were 5,091 interventions spanning 3,967 patient encounters between nine ambulatory oncology clinic pharmacists. The average time per encounter in the 6-month time frame was 22.4 minutes. There were 92 respondents to the survey (61.7% response rate). Overall, responses showed that the clinical pharmacists add value to patient care and are integral members of the team., Conclusions: Although previous studies have described pharmacist activities in outpatient oncology clinics, this study showed a larger number and variety of clinical pharmacist activities in outpatient cancer clinics to improve patient care. Future directions include conducting prospective, controlled studies to link pharmacist activities to tangible outcomes., Competing Interests: The authors have no conflicts of interest to disclose., (© 2020 Harborside™.)

The purpose of this review is to describe how pregnant and postpartum women with substance use disorders (SUDs) experience health care encounters in prenatal care, labor and delivery, postpartum, and nursery/neonatal intensive care unit (NICU) settings. Findings from 23 qualitative studies on the topic were synthesized using a metasummary approach. The majority of the studies revealed that pregnant and postpartum women with SUDs tend to experience their health care encounters as conflictual, although some studies revealed that some women experience their health care encounters as supportive. The results of metasummary included a taxonomy of health care encounters. Five types of adverse encounters were identified: judgmental, disparaging, scrutinizing, disempowering, and deficient-care. Three types of beneficial encounters were identified: recovery-based, accepting, and effective-care. The findings suggest the importance of stigma awareness, therapeutic patient-provider communication, patient activation, and integrated care.

Objective: Wound healing is a complex process involving the dynamic interplay of various types of cells and bioactive factors. Impaired wound healing is characterized by a loss in synchronization of the process, resulting in non-healing chronic wounds. Human amniotic membrane (AM) has been shown to be effective in the management of chronic wounds. Recently, a viable lyopreserved AM (VLAM) has been developed. The VLAM retains the structural, molecular, and functional properties of fresh AM with the advantage of a long shelf life for living tissue at ambient temperatures. The objective of this study was to evaluate the effects of VLAM on the impaired wound microenvironment and wound closure in db/db mice. Approach: VLAM or saline gel (control) was applied weekly to 7-mm excisional wounds in diabetic (db/db) mice. Wound appearance and size were assessed weekly. Inflammation and redox state in wounds were tested by cytokine gene and protein expression, and by catalase and glutathione peroxidase activities, respectively. Wound tissue granulation and neovascularization were assessed histologically. Results: Diabetic wounds treated with VLAM closed faster than control wounds. On an average, VLAM-treated wounds closed 4 days faster than the control wounds, with a significantly faster rate of closure at days 7 and 14 as compared with control wounds. The faster closure correlated with a decrease in the expression of proinflammatory factors and oxidative stress, and an increase in angiogenesis and dermal thickness. Innovation: Effects of VLAM on a chronic wound microenvironment and underlying molecular mechanisms were investigated for the first time. Conclusion: VLAM accelerates wound closure in db/db mice by decreasing inflammation and oxidative stress and supporting wound tissue granulation, neovascularization, and re-epithelialization.

Post-operative adhesions, a common complication of surgery, cause pain, impair organ functionality, and often require additional surgical interventions. Control of inflammation, protection of injured tissue, and rapid tissue repair are critical for adhesion prevention. Adhesion barriers are biomaterials used to prevent adhesions by physical separation of opposing injured tissues. Current adhesion barriers have poor anti-inflammatory and tissue regenerative properties. Umbilical cord tissue (UT), a part of the placenta, is inherently soft, conforming, biocompatible, and biodegradable, with antimicrobial, anti-inflammatory, and antifibrotic properties, making it an attractive alternative to currently available adhesion barriers. While use of fresh tissue is preferable, availability and short storage time limit its clinical use. A viable cryopreserved UT (vCUT) "point of care" allograft has recently become available. vCUT retains the extracellular matrix, growth factors, and native viable cells with the added advantage of a long shelf life at -80 °C. In this study, vCUT's anti-adhesion property was evaluated in a rabbit abdominal adhesion model. The cecum was abraded on two opposing sides, and vCUT was sutured to the abdominal wall on the treatment side; whereas the contralateral side of the abdomen served as an internal untreated control. Gross and histological evaluation was performed at 7, 28, and 67 days post-surgery. No adhesions were detectable on the vCUT treated side at all time points. Histological scores for adhesion, inflammation, and fibrosis were lower on the vCUT treated side as compared to the control side. In conclusion, the data supports the use of vCUT as an adhesion barrier in surgical procedures.

Human amniotic membrane (AM) has a long history of clinical use for wound treatment. AM serves as a wound protective barrier maintaining proper moisture. AM is anti-inflammatory, anti-microbial and antifibrotic, and supports angiogenesis, granulation tissue formation and wound re-epithelialization. These properties of AM are attributed to its native extracellular matrix, growth factors, and endogenous cells including mesenchymal stem cells. Advances in tissue preservation have helped to overcome the short shelf life of fresh AM and led to the development of AM products for clinical use. Viable cryopreserved amnion (VCAM), which retains all native components of fresh AM, has shown positive outcomes in clinical trials for wound management. However, cryopreservation requires ultra-low temperature storage and shipment that limits widespread use of VCAM. We have developed a lyopreservation technique to allow for ambient storage of living tissues. Here, we compared the structural, molecular, and functional properties of a viable lyopreserved human amniotic membrane (VLAM) with properties of VCAM using in vitro and in vivo wound models. We found that the structure, growth factors, and cell viability of VLAM is similar to that of VCAM and fresh AM. Both, VCAM and VLAM inhibited TNF-α secretion and upregulated VEGF expression in vitro under conditions designed to mimic inflammation and hypoxia in a wound microenvironment, and resulted in wound closure in a diabetic mouse chronic wound model. Taken together, these data demonstrate that VLAM structural and functional properties are equivalent to VCAM but without the constraints of ultra-low temperature storage., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: All authors are full time paid employees of Osiris Therapeutics Inc.

Chronic wounds remain a large problem in the field of medicine and are often associated with risk of infection and amputation. Recently, a commercially available human cryopreserved viable amniotic membrane (hCVAM) has been shown to effectively promote wound closure and reduce wound-related infections. A sprevious study indicates that hCVAM can inhibit the growth of bacteria associated with chronic wounds. In the present study, we investigated the mechanism of hCVAM antimicrobial activity. Our data demonstrate that antimicrobial activities against common pathogens in chronic wounds such as P.aeruginosa, S.aureus and Methicillin-resistant S.aureus (MRSA) are mediated via the secretion of soluble factors by viable cells in hCVAM and that these factors are proteins in nature. Further, we show that genes for antimicrobial peptides (AMPs) including human beta-defensins (HBDs) are expressed by hCVAM and that expression levels positively correlate with antimicrobial activity of hCVAM. At the protein level, our data indicate that HBD2 and HBD3 are secreted by hCVAM and directly contribute to its activity against P. aeruginosa. These data provide evidence that soluble factors including AMPs are hCVAM antimicrobial agents and are consistent with a role for AMPs in mediating antimicrobial properties of the membrane.

Health care is increasingly complex, as nurses navigate working in teams and conveying critical information to others. Clear communication and accuracy are critical for nurses because they communicate to patients and other members of the health care team. Art, and more specifically, Visual Thinking Strategies (VTS), are ways for nurses to practice communication and clear articulation of ideas. VTS also allows nurses to explore finding their voices and working with others to provide safe and effective communication among the team, including patients and their families.

Visual Thinking Strategies (VTS) is a structured art-viewing technique designed to teach critical thinking and aesthetic appreciation. Literature on how VTS might be used in nursing is just emerging. This qualitative descriptive study examined written responses to how 14 doctorate of nursing practice students thought they might use VTS in their practice after engaging in a classroom session. Three themes emerged for how nurses might use VTS: Facilitating Interpersonal Relationships, Changing Thinking in Practice, and As a Teaching Tool. This study contributes to the growing body of literature that suggests that art and VTS and can be used in nursing with practitioners of all levels to promote conversations that involve listening intently and considering other possibilities. J Contin Educ Nurs. 2017;48(8):365-368., (Copyright 2017, SLACK Incorporated.)

We report on the development of a highly miniaturized vacuum package for use in an atomic clock utilizing trapped ytterbium-171 ions. The vacuum package is approximately 1 cm(3) in size and contains a linear quadrupole RF Paul ion trap, miniature neutral Yb sources, and a non-evaporable getter pump. We describe the fabrication process for making the Yb sources and assembling the vacuum package. To prepare the vacuum package for ion trapping, it was evacuated, baked at a high temperature, and then back filled with a helium buffer gas. Once appropriate vacuum conditions were achieved in the package, it was sealed with a copper pinch-off and was subsequently pumped only by the non-evaporable getter. We demonstrated ion trapping in this vacuum package and the operation of an atomic clock, stabilizing a local oscillator to the 12.6 GHz hyperfine transition of (171)Y b(+). The fractional frequency stability of the clock was measured to be 2 × 10(-11)/τ(1/2).