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Background: Xenotransplantation has made significant advances recently using pigs genetically engineered to remove carbohydrate antigens, either alone or with addition of various human complement, coagulation, and anti-inflammatory ''transgenes''. Here we evaluated results associated with gene-edited (GE) pig hearts transplanted in baboons using an established costimulation-based immunosuppressive regimen and a cold-perfused graft preservation technique., Methods: Eight baboons received heterotopic abdominal heart transplants from 3-GE (GalKO.β4GalNT2KO.hCD55, n = 3), 9-GE (GalKO.β4GalNT2KO.GHRKO.hCD46.hCD55. TBM.EPCR.hCD47. HO-1, n = 3) or 10-G (9-GE+CMAHKO, n = 2) pigs using Steen's cold continuous perfusion for ischemia minimization. Immunosuppression (IS) included induction with anti-thymocyte globulin and αCD20, ongoing αCD154, MMF, and tapered corticosteroid., Results: All three 3-GE grafts functioned well initially, but failed within 5 days. One 9-GE graft was lost intraoperatively due to a technical issue and another was lost at POD 13 due to antibody mediated rejection (AMR) in a baboon with a strongly positive pre-operative cross-match. One 10-GE heart failed at POD113 with combined cellular and antibody mediated rejection. One 9-GE and one 10-GE hearts had preserved graft function with normal myocardium on protocol biopsies, but exhibited slowly progressive graft hypertrophy until elective necropsy at POD393 and 243 respectively. Elevated levels of IL-6, MCP-1, C-reactive protein, and human thrombomodulin were variably associated with conditioning, the transplant procedure, and clinically significant postoperative events., Conclusion: Relative to reference genetics without thrombo-regulatory and anti-inflammatory gene expression, 9- or 10-GE pig hearts exhibit promising performance in the context of a clinically applicable regimen including ischemia minimization and αCD154-based IS, justifying further evaluation in an orthotopic model., (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Introduction: Unrealistic patient expectations for wait times can lead to poor satisfaction. This study's dual purpose was: (1) to address disparities between patients' perceived priority level and the Emergency Severity Index (ESI) assigned by emergency room triage nurses; and (2) to evaluate validity and reliability of using the Patient Perception of Priority to be Seen Survey (PPPSS) to investigate patient expectations for emergency department urgency., Methods: A two-group pretest-posttest quasi-experimental approach compared patient urgency opinions to nurse urgency ratings with and without a scripted educational intervention. This tested how closely patient perceptions were related to triage nurse ratings., Results: Reliability for the PPPSS was acceptable (reliability = 0.75). Patients who were rated lower urgency on the ESI by triage nurses tended to self-report higher urgency (rho = -0.44, P < .01). Attitudes were more consistent in the posttest patient group who were exposed to the scripted verbal description of emergency department procedures (χ 2 (1, N = 352) = 8.09, P < .01). Patients who disagreed with emergency nurse scores tended to be younger on average (eg, < 40 years old; rho = 0.69, P < .01). Male identified patients tended to be rated both by nurses and themselves as higher urgency (beta = 0.18, P = .02)., Discussion: We recommend the PPPSS for nurses and researchers to quickly assess patient expectations. Additionally, promoting patient understanding through a scripted educational strategy about the ESI system may also result in improvements in communication between patients and nurses., (Copyright © 2022 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Amyotrophic lateral sclerosis (ALS) is a progressive fatal neurodegenerative disease that is characterized by the death of motor neurons in the spinal cord, brain stem, and motor cortex that are responsible for voluntary movement. For unknown reasons, military veterans are approximately twice as likely as the public to be given a diagnosis of ALS. Currently, there is no cure for ALS. The only US Food and Drug Administration-approved disease-modifying medication is riluzole (Rilutek), which may slow ALS progression but only minimally increases survival time. Multidisciplinary care in ALS has been shown to improve survival time and improve quality of life. The purpose of this article is to describe the development of an innovative evidence-based interprofessional healthcare program in a Veterans Administration medical center to address the needs of this vulnerable veteran population.

Acute respiratory distress syndrome (ARDS) is a condition with a high morbidity and mortality rate, and treatment is often long and costly. Prone positioning is a rarely used intervention for patients with this syndrome, although research suggests it may be effective. A literature search was undertaken to examine the effects of prone positioning on oxygenation, morbidity and mortality in patients with ARDS. It revealed that prone positioning, when used with low tidal volume ventilation over an extended period, may reduce mortality rates in selected patients with severe ARDS. The selection of patients with severe ARDS for prone positioning should be done on a case-by-case basis to maximise benefits and minimise complications. Further research is required on the use of prone positioning in patients with severe ARDS to support or disclaim the therapy's use in practice, and to compare confounding variables such as ideal prone duration and mechanical versus manual pronation.

Purpose: Ineffective communication is the most frequently reported cause of sentinel events in U.S. hospitals. Examining hospital processes and systems of communication, and standardizing communication practices can reduce the risks to patients in the acute care environment. The purpose of this paper is to describe the use of an innovative, translating-research-into-practice model to generate and test a cost-effective, easy to use, best-practice protocol for nurse-to-nurse shift handoffs in a medium-sized magnet-designated community hospital in the United States., Theoretical Framework: Roger's Diffusion of Innovations Theory was used as the overall framework for the translational model with Orlando's theory providing theoretical evidence for the best practice protocol., Approach: Using the first three steps of the model, methods included: (1) identifying clinical problems related to shift handoffs; (2) appraising and systematically evaluating the strength of theoretical, empirical, and clinical evidence; and (3) translating this evidence into a best-practice patient-centered, standardized protocol for nurse-to-nurse shift handoffs., Conclusions/implications: Meaningful clinician participation in the development of a standardized, evidence-based, patient-centered approach to nurses' change-of-shift handoffs was achieved. Using the Collaborative Research Utilization Model can facilitate the integration of new knowledge both in the clinical and academic community.

Purpose: A research roundtable was held in an urban community hospital in the United States to determine the strength, usefulness, and feasibility of empirical and clinical evidence evaluated in a systematic review assessing capillary refill., Approach: The roundtable was undertaken to provide an additional dimension for the development of a best-practice guideline. Current practices and policies in this acute care hospital were examined concerning the strength of the evidence., Conclusions and Recommendations: Isolated performance of capillary refill assessment is of limited value and no nursing interventions rely solely on this measure. Future research should be directed toward evaluation and comparative analyses of alternate methods of evaluating peripheral perfusion.

While millions of dollars are being spent developing the seeds of research to improve the care we give to patients, significant barriers to using empirical evidence by health care professionals and policymakers still exist. The gap between what we know from research and what we use in practice is at the heart of the translation research problem. How do we get empirical knowledge uptake and use by clinicians in the fields of practice? In addition, how do we measure if practice changes are occurring? This article describes a program of translation research in which the intervention, called the Collaborative Research Utilization model, was developed and tested in four clinical studies over 18 years.

We used hierarchical clustering to examine gene expression profiles generated by serial analysis of gene expression (SAGE) in a total of nine normal lung epithelial cells and non-small cell lung cancers. Separation of normal and tumor, as well as histopathological subtypes, was evident by using the 3,921 most abundant transcript tags. This distinction remained when only 115 highly differentially expressed tags were used. Furthermore, these 115 transcript tags clustered into groups suggestive of the unique biological and pathological features of the different tissues examined. Adenocarcinomas were characterized by high-level expression of small airway-associated or immunologically related proteins, whereas squamous cell carcinomas overexpressed genes involved in cellular detoxification or antioxidation. The messages of two p53-regulated genes, p21(WAF1/CIP1) and 14-3-3final sigma, were consistently underexpressed in the adenocarcinomas, suggesting that the p53 pathway itself might be compromised in this cancer type. Gene expression patterns observed by SAGE were consistent with results obtained by quantitative real-time PCR or cDNA array analyses by using a total of 43 lung tumor and normal samples. Thus, although derived from only a few tissue libraries, gene expression profiles obtained by using SAGE most likely represent an unbiased yet distinctive molecular signature for the most common forms of human lung cancer.

The generation of research-based knowledge is incomplete unless it reaches clinicians at the point of care. Despite major advances in clinical research related to pain management, inadequate pain relief has become a significant quality issue in hospitalized patients, which has created an imperative for research-based pain management. Using a collaborative research utilization model, multidisciplinary academic scientists were paired with clinicians and undergraduate and graduate students to form a partnership that (1) examined the research base in pain management, (2) generated a research-based standard for pain management, and (3) evaluated the effect of that standard on four patient outcome variables in a 230-bed teaching hospital. A 2-group, pretest-intervention-posttest, quasi-experimental clinical trial composed of 173 surgical and oncology subjects was conducted. Subjects whose caregiver used the new standard had less pain during their hospital stay, less interference by pain with quality-of-life indicators, and greater satisfaction with the interventions used as well as caregiver responsiveness to their pain. Interestingly, each of these improvements decreased after their discharge home. These results strongly suggest the need for better postdischarge preparation for pain management and for further development and testing of pain management standards in postdischarge settings. They also provide the basis for extending the model to address other situations in which there is a lag between the promising results of empirical research and their integration into practice.

The article reports a study that tested a practical multidisciplinary approach to address the prevailing research-to-practice gap in pain management. By means of a collaborative research utilization model, academic scientists and students from two affiliating colleges of nursing were paired with clinicians from medicine, nursing, social work, pastoral care, and physical therapy to form three partnerships to develop and evaluate 14 pain management clinical pathways. Results showed that patients whose caregiver used the pathways had less pain across their hospital stay, less interference by pain in nearly all quality of life indicators, and greater satisfaction with caregiver responsiveness to their pain. Each of these improvements reversed after discharge, however.

It is not uncommon for a decade to pass between the time a research problem is identified and the time that research-based solutions are translated into standards for care. This quasi-experimental study demonstrated the effectiveness of a collaborative research utilization model directed towards the transfer of specific research-based knowledge (pain assessment) into practice for the purpose of helping to solve pain management problems. At the same time, nurses who participated in the model significantly improved their competency in research utilization and their attitudes towards research when compared to a control group who did not participate in the model.

The amount of time and the type of experience needed by undergraduate students in the clinical setting to actually practice nursing has been the subject of many debates between nurses in academe and service. Rather than blaming each other for the culture shock and transition problems of neophyte nurses, members of the academic and practice community in Rhode Island decided to address the problem together. The development of the collaborative program described in this article grew out of a research study and was coordinated through the efforts of nurses from service and academe. The central outcome of this statewide consortium's project was to increase the students' level of nursing competencies. "Turf" issues that related to the colleges and the hospitals involved became secondary. Everyone involved believed that students from different collegiate programs working together presented exciting opportunities to share and learn from one another. In addition, other outcomes included increased recruitment and retention of these baccalaureate-prepared nurses in the hospitals, and greater ease in their orientation and transition. In addition, a cluster of three research studies were conducted by members of the consortium. This ongoing program, in which nurses in education and service are working together in a statewide consortium to break down the turf issues that separated them, is achieving outcomes that could not have been accomplished had it been undertaken independently. This article describes the process used to develop, implement, and evaluate such a program.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to explore the relative contribution of eight independent variables in explaining novices' perceived variation in role mastery 3 months following their appointment. The study sample included 75 novice graduate nurses in a large tertiary teaching hospital. A correlational design using the multivariate procedure of step-wise multiple regression was used. On day one of orientation, the Schwerian Six-Dimensional Scale of Nursing Performance was administered to the novices, their preceptors, and head nurses. To obtain a measure of the nursing unit's collective expertise, its job satisfaction, and its role socialization, nurse educators rated their units using the Nursing Practice Group Role Mastery Assessment Scale. Participation in bicultural training was documented by attendance. Three months later, the novices were posttested using the Schwerian Scale as the criterion variable. Of the eight potential explanatory variables, only four entered the regression equation, explaining 40% of the variance (p less than .05). These were: entry-level role mastery, the nursing unit's collective expertise, its job satisfaction, and its role socialization. Interestingly, the head nurse's role mastery, and the three interventions used to address role transition problems were not predictors. Also, specific competency weaknesses in novices paralleled their experienced peers in the areas of assessing priorities, written communication, and skills salient to discharge planning.

Locus of Control research has established that college students are becoming more external, and that internality is preferable. If an external locus of control is associated with poor self-esteem, alienation, depression, and "burn out" in nurses as it is with other individuals, then we need to reverse this trend. Lefcourt (1976) tells us that in the future, methods fostering internality will be crucial. Toffler (1980) says that to break out of the rigid mentality of the Second Wave, future-oriented nurses must be self-responsible. Self-responsible, internally controlled practitioners will enable themselves and the nursing profession to grow as they will anticipate and participate in the selection of the knowledge, skills, and characteristics they need to grow. The purpose of this study was to determine if a course which explores the transition into a futuristic-oriented professional nursing role would move registered nurse students in a baccalaureate program toward stronger internality. A basic pretest-intervention-post test experimental design was used and results of an analysis of covariance significantly determined the efficacy of the course in encouraging greater internality, F (3,60) = 49.55, p less than .0001.