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Aims Knockout (KO) of the mitochondrial Ca2+ uniporter (MCU) in mice abrogates mitochondrial Ca2+ uptake and permeability transition pore (PTP) opening. However, hearts from global MCU-KO mice are not protected from ischaemic injury. We aimed to investigate whether adaptive alterations occur in cell death signalling pathways in the hearts of global MCU-KO mice. Methods and results First, we examined whether cell death may occur via an upregulation in necroptosis in MCU-KO mice. However, our results show that neither RIP1 inhibition nor RIP3 knockout afford protection against ischaemia-reperfusion injury in MCU-KO as in wildtype (WT) hearts, indicating that the lack of protection cannot be explained by upregulation of necroptosis. Instead, we have identified alterations in cyclophilin D (CypD) signalling in MCU-KO hearts. In the presence of a calcium ionophore, MCU-KO mitochondria take up calcium and do undergo PTP opening. Furthermore, PTP opening in MCU-KO mitochondria has a lower calcium retention capacity (CRC), suggesting that the calcium sensitivity of PTP is higher. Phosphoproteomics identified an increase in phosphorylation of CypD-S42 in MCU-KO. We investigated the interaction of CypD with the putative PTP component ATP synthase and identified an approximately 50% increase in this interaction in MCU-KO cardiac mitochondria. Mutation of the novel CypD phosphorylation site S42 to a phosphomimic reduced CRC, increased CypD-ATP synthase interaction by approximately 50%, and increased cell death in comparison to a phospho-resistant mutant. Conclusion Taken together these data suggest that MCU-KO mitochondria exhibit an increase in phosphorylation of CypD-S42 which decreases PTP calcium sensitivity thus allowing activation of PTP in the absence of an MCU-mediated increase in matrix calcium. [ABSTRACT FROM AUTHOR]

With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, Texas nurses were faced with the rapid uptake of technology driven by this legislation. Texas Nurses Association and Texas Organization for Nursing Leadership formed a partnership to collectively track the impact on practicing nurses. The Health IT Committee was commissioned to evaluate the changing health information technology environment and associated solutions. As such, a study in 2015, entitled "Statewide Study Assessing the Experiences of Nurses with their Electronic Health Records," was conducted. The follow-up study in 2020 was conducted to compare 2015 and 2020 findings to identify improvements made on nurses' satisfaction with EHRs and identify improvement opportunities. The study design was an exploratory descriptive comparative analysis with a cross-sectional survey from a random sample of Texas nurses for the two study periods of 2015 (n = 1177) and 2020 (n = 1117). The Clinical Information Systems Implementation Evaluation Scale and a demographic survey including the Meaningful Use Maturity-Sensitive Index were the measurement instruments. Results and key covariates are discussed along with recommendations for achieving more mature EHRs and more mature organizational culture and leadership., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

For nearly 50 years, Therapeutic Touch (TT) has contributed to advancing holistic nursing practice and has been recognized as a uniquely human approach to healing. This narrative explores the development of a practice-based theory of healing through TT, which occurred between 2010 and 2016. Through the in-depth self-inquiry of participatory reflective dialogue in concert with constant narrative analysis, TT practitioners revealed the meaning of healing within the context of their TT practice. As the community of TT experts participated in an iterative process of small group and community dialogues with analysis and synthesis of emerging themes, the assumptions and concepts central to a theory of healing emerged, were clarified and verified. Exemplars of practice illustrate the concepts. A model of the theory of healing illuminates the movement and relationship among concepts and evolved over time. Feedback from nursing and inter-professional practitioners indicate that the theory of healing, while situated within the context of TT, may be useful in advancing holistic nursing practice, informing healing and caring approaches, stimulating research and education, and contributing to future transformations in health care.

Nursing professionals are at the frontline of the health information technology revolution. The Texas Nurses Association and Texas Organization of Nurse Executives partnered to evaluate the changing health technology environment in Texas, in particular the nurses' satisfaction with the use of clinical information systems. A descriptive exploratory study using the Clinical Information System Implementation Evaluation Scale and a newly developed Demographic Survey and the Meaningful Use Maturity-Sensitive Index, with a narrative component, was conducted in 2014 and 2015. Nurses across Texas received an electronic invitation to participate in the survey, resulting in 1177 respondents. Exploratory factor analysis revealed that variables of the Meaningful Use Maturity-Sensitive Index and Clinical Information System Implementation Evaluation Scale show strong interrater reliability, with Cronbach's α scores of .889 and .881, respectively, and thereby inform the survey analysis, indicating and explaining variations in regional and institutional trends with respect to satisfaction. For example, the maturity of a clinical information system within an organization and age of the nurse significantly influence the probability of nurse satisfaction (P < .05). Qualitative analysis of nurses' narratives further explained the nurses' experiences. Recommendations for future research and educational were identified.

Objective: To determine the frequency and severity of 8 symptoms in persons with multiple sclerosis (MS) and to examine the association between these symptoms and community integration and mental health., Design: Cross-sectional survey that assessed 8 symptoms (pain, fatigue, imbalance, numbness, weakness, shortness of breath, vision loss, and memory loss), disease progression (self-report version of the Expanded Disability Status Scale), community integration, and mental health., Setting: Community., Participants: Adults with self-reported MS who responded to a mailed survey (N=180)., Interventions: Not applicable., Main Outcome Measures: The presence and intensity of symptoms were measured with a symptoms checklist. Community integration was assessed with the Community Integration Questionnaire, and mental health was measured by the Mental Health Index of the Medical Outcomes Study 36-Item Short-Form Health Survey., Results: The average number of symptoms reported was 5.07±2.18. The most common symptoms (fatigue, weakness, and imbalance) were also rated as the most severe. Not all symptoms were associated with level of disease progression or with MS subtype. Symptoms related to mobility were more likely to be associated with these variables. The 8 symptoms as a whole accounted for significant amounts of variance (range, 13%-21%) in measures of community integration and mental health, with specific symptoms making differential independent contributions to these measures., Conclusions: This study demonstrates that most individuals with MS report a number of bothersome symptoms. Type of MS or level of progression does not tell the whole story regarding the impact of symptoms., (Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Although chronic pain is common among persons with multiple sclerosis (MS), little is known about the utilization and patients' perception of the effectiveness of pain treatments in MS., Objectives: The objectives were to: (1) identify specific treatments currently used for pain relief by adults with MS; (2) examine patients' perceptions of the effectiveness of each of these treatments; and (3) examine rates of health care utilization, specifically provider and emergency department visits, for pain., Design: Cross-sectional survey., Methods: One hundred twenty-five community-dwelling participants with MS and pain completed a postal survey that measured demographics, MS disease, pain, pain treatments, perceived effectiveness of treatments, and health care utilization., Results: The majority (89.6%) of the sample reported use of a variety of and multiple pain treatments (range = 1-19, median = 9.0, mean = 9.0, SD = 4.2); few were rated as providing pain relief. Non-prescription pain relievers were the most commonly reported treatment. Physical treatment modalities were also common. The treatments that were reported by patients to provide the greatest pain relief, such as hypnosis, nerve blocks, and marijuana, were not those that were the most frequently used. Overall, 75% reported at least one visit to a provider for pain in the past six months; participants made, on average, 9.7 visits for pain during this same time period. Emergency department visits explicitly for pain were reported by 11% of respondents., Conclusions: These findings suggest that pain is inadequately treated from the perspective of persons with MS and results in a high level of health care utilization., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The art of improvisation is an essential component of responding on the front lines of caring. Improvisation expresses the nurse's capacity to perceive the changing patterns of patients and their environments in ways that foster creative and innovative approaches to meeting healthcare needs. Many holistic nurses across the country are working on the front lines of caring, improvising and implementing projects to create change within their communities. This article examines improvisation within the context of the art and science of nursing, and proposes that improvisation reflects qualities within holistic nursing that are essential in contemporary health care.

Objective: To describe the prevalence, intensity, and functional impact of the following types of pain associated with upper-limb loss: phantom limb, residual limb, back, neck, and nonamputated-limb pain., Design: Cross-sectional survey; 104 respondents with upper-limb loss at least 6 months postamputation completed measures of pain intensity, interference, disability, and health-related quality-of-life., Results: Nearly all (90%) of the respondents reported pain, with 76% reporting more than one pain type. Phantom-limb pain and residual-limb pain were the most prevalent (79% and 71%, respectively), followed by back (52%), neck (43%), and nonamputated-limb pain (33%). Although nonamputated-limb pain was least prevalent, it was reported to cause the highest levels of interference and pain-related disability days. Self-reported quality-of-life was significantly lower for individuals with each type of pain compared with those without any pain. Age, time since amputation, and cause of amputation were not associated with pain., Conclusions: In addition to pain in the phantom and residual limb, back, neck, and nonamputated-limb pain are also common after upper-limb loss. All of these pain types are associated with significant disability and activity interference for some individuals, suggesting that assessment of multiple pain types in persons with upper-limb amputation may be important.

Thirty-seven adults with spinal-cord injury and chronic pain were randomly assigned to receive 10 sessions of self-hypnosis (HYP) or EMG biofeedback relaxation (BIO) training for pain management. Participants in both treatment conditions reported substantial, but similar, decreases in pain intensity from before to after the treatment sessions. However, participants in the HYP condition, but not the BIO condition, reported statistically significant decreases in daily average pain pre- to posttreatment. These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up. Participants in the HYP condition, but not the BIO condition, also reported significant pre- to posttreatment increases in perceived control over pain, but this change was not maintained at the 3-month follow-up.

Unlabelled: The current study sought to examine how changes in pain-related beliefs and coping responses are related to changes in pain interference and psychological functioning in individuals with spinal cord injuries (SCI) and pain. To measure longitudinal changes in these variables, respondents completed a survey that included measures of pain intensity, pain interference, and psychological functioning, as well as specific psychosocial variables (pain-related beliefs, coping, and social support) and then completed the same survey 6 months later; analyses included only the individuals who reported pain at both times (n = 40). Demographic and injury-related variables were also assessed, but none were found to be significantly associated with changes in functioning. Changes in catastrophizing and belief in one's ability to control pain were each significantly associated with changes in the outcome variables: Greater pain interference and poorer psychological functioning. Changes in specific coping strategies and social support were not predictors of changes in pain, interference, or psychological functioning. These findings support a biopsychosocial model of pain in persons with SCI. Intervention studies targeting maladaptive pain-related beliefs and catastrophizing may help to identify the causal nature of these relationships and may improve multidisciplinary treatment of pain in SCI., Perspective: Intervention studies targeting catastrophizing and maladaptive pain-related beliefs may be the next step in determining which variables play a causal role in the pain interference and psychological functioning of individuals with pain and SCI.

Background: Therapeutic touch (TT), a complementary therapy, has been shown to decrease stress, anxiety, and pain in adults and children, as well as improve mobility in patients with arthritis and fibromyalgia. However, less has been reported about the effectiveness of this therapy with infants, particularly preterm infants., Objectives: The aims of this research study were to explore the nature of the use of TT with preterm infants and describe a TT treatment process for this vulnerable population., Design: Narrative inquiry and qualitative descriptive methods were used to discover knowledge about how TT is used with preterm infants., Data Collection: Telephone/in-person interviews and written narratives provided the data describing nurses' use of TT with preterm infants., Participants: The participants were registered nurses who practiced TT with preterm infants for varying years of experience., Results: The participants described the responses of infants, 25 to 37 weeks postgestational age, whom they treated with TT. The infants' responses to TT included reduced heart and respiratory rates, enhanced ability to rest, improved coordination in sucking, swallowing, and breathing, and a greater ability to engage with the environment. The practitioners described the phases and elements of TT for preterm infants, which revealed unique patterns, for example, the treatment phase included the elements of smoothing and containing., Conclusion: The description that emerged from the practitioners' narratives of the TT treatment process for preterm infants provides preliminary data for the systematic use and evaluation of TT as an adjunct to facilitating preterm infants' physiological, behavioral, energy field development, and well-being.

Data from 26 participants in a case series of hypnotic analgesia for chronic pain were examined to determine the long-term effects of hypnosis treatment. Statistically significant decreases in average daily pain intensity, relative to pretreatment values, were observed at posttreatment and at 3- and 9-month follow-up but not at 6- or 12-month follow-up. The percent of participants who reported clinically meaningful decreases in pain were 27%, 19%, 19%, and 23%, at the 3-, 6-, 9-, and 12-month follow-up points, respectively. Moreover, at 12-months posttreatment, 81% of the sample reported that they still used the self-hypnosis skills learned in treatment. Overall, the results indicate that about 20% of the sample obtained substantial and lasting long-term reductions in average daily pain following hypnosis treatment and that many more continue to use self-hypnosis up to 12 months following treatment.

This study identified clinical (e.g., etiology) and demographic factors related to prosthesis use in persons with upper- and lower-limb amputation (ULA and LLA, respectively) and the effect of phantom limb pain (PLP) and residual limb pain (RLP) on prosthesis use. A total of 752 respondents with LLA and 107 respondents with ULA completed surveys. Factors related to greater use (hours per day) for persons with LLA included younger age, full- or part-time employment, marriage, a distal amputation, an amputation of traumatic etiology, and an absence of PLP. Less use was associated with reports that prosthesis use worsened RLP, and greater prosthesis use was associated with reports that prosthesis use did not affect PLP. Having a proximal amputation and reporting lower average PLP were related to greater use in hours per day for persons with an ULA, while having a distal amputation and being married were associated with greater use in days per month. Finally, participants with LLA were significantly more likely to wear a prosthesis than those with ULA. These results underscore the importance of examining factors related to prosthesis use and the differential effect that these variables may have when the etiology and location of amputation are considered.

Improvisation has long been considered a function of music, dance, and the theatre arts. An exploration of the definitions and characteristics of this concept in relation to the art and practice of nursing provide an opportunity to illuminate related qualities within the field of nursing. Nursing has always demonstrated improvisation because it is often required to meet the needs of patients in a rapidly changing environment. However, little has been done to identify improvisation in the practice of nursing or to teach improvisation as a nursing knowledge-based skill. This article strives to explore the concept of improvisation in nursing, to describe the characteristics of improvisation as applied to nursing, and to utilize case studies to illustrate various manifestations of improvisation in nursing practice.

Unlabelled: Although previous research suggests that preamputation pain is a risk factor for pain after amputation, little is known about the association between acute postsurgical pain and chronic amputation-related pain. The current prospective study examined the associations of preamputation pain and acute postamputation pain with chronic amputation-related pain. The sample consisted of patients with lower limb amputation (N = 57) who provided both preamputation and postamputation data during a 2-year study period. Preamputation pain intensity and duration were assessed before amputation; acute phantom limb pain (PLP) and residual limb pain (RLP) intensity were assessed on postsurgical days 4 and 5. Acute PLP intensity was the only significant independent predictor of chronic PLP intensity at 6 and 12 months after amputation, whereas preamputation pain intensity was the only significant predictor of chronic PLP intensity at 24 months. Similarly, acute RLP was found to be the best overall predictor of chronic RLP. Other variables (age, gender, level and etiology of amputation, amount of postsurgical pain medication, and duration of preamputation pain) were not associated with chronic pain. These results suggest that higher levels of pain either before or soon after amputation might help to identify individuals at greatest risk for chronic pain problems and most in need of early, intensive pain interventions., Perspective: This study suggests that both preamputation pain and acute pain soon after amputation might be associated with bothersome chronic pain. The results support further research on acute pain mechanisms and the effectiveness of early interventions aimed at preventing or managing amputation-related pain.

Biopsychosocial models of chronic pain that recognize psychological and environmental factors as important aspects of adjustment to pain have been proposed for understanding chronic pain and related suffering in persons with multiple sclerosis (MS), but such models have not been empirically tested. The objective of this study was to test such a model by evaluating the associations of several psychosocial variables (i.e., pain-related catastrophizing, perceived social support, pain beliefs, and pain coping) with pain intensity, pain interference with functioning, and psychological functioning in persons with chronic pain and MS, after controlling for demographic and disease-related factors. Participants were 125 community-dwelling persons with MS and pain who completed a mailed questionnaire that included measures of pain intensity and interference, psychological functioning, catastrophizing, social support, and pain beliefs and coping. The psychosocial variables accounted for an additional 25% of the variance in average pain intensity after controlling for demographic and disease-related variables (p<.001). These variables explained an additional 22% of the variance in pain-related interference (p<.001) and 43% of the variance in psychological functioning (p<.001), after adjusting for demographic and MS-related variables and average pain intensity. Catastrophizing was consistently and independently associated with all criterion measures, whereas social support, pain beliefs, and pain coping were associated with some criterion measures but not others. The results provide empirical support for a biopsychosocial understanding of chronic pain in MS and suggest that specific psychosocial factors (e.g., catastrophizing) may be important regarding adjustment to pain in persons with MS.

Case study research suggests that hypnosis treatment may provide benefits that are not necessarily the target of specific suggestions. To better understand satisfaction with and the beneficial "side effects" of hypnosis treatment, questions inquiring about treatment satisfaction and treatment benefits were administered to a group of 30 patients with chronic pain who had participated in a case series of hypnotic analgesia treatment. The results confirmed the authors' clinical experience and showed that most participants reported satisfaction with hypnosis treatment even when the targeted symptom (in this case, pain intensity) did not decrease substantially. Study participants also reported a variety of both symptom-related and nonsymptom-related benefits from hypnosis treatment, including decreased pain, increased perceived control over pain, increased sense of relaxation and well-being, and decreased perceived stress, although no single benefit was noted by a majority of participants.

Much remains unknown about the scope, nature, and impact of pain on the lives of persons with multiple sclerosis (MS). In the present study, 180 community dwelling adults with MS completed a postal survey that included demographic measures, MS disease measures, and several standardized measures of pain, including pain intensity, variability, location, and pain-related interference. Some 66% of the sample reported pain, 25% of whom reported severe pain. Persons with pain reported an average of 6.6 distinct pain sites. Using the Brief Pain Inventory Interference Scale, the average level of overall pain interference was 3.33 (0-10 scale) in the group reporting pain. The highest levels of pain interference were reported for sleep, recreational activities, and work in and outside the home. Persons with pain were more likely to report greater MS disease severity, poorer psychological functioning, and poorer health than persons with MS but not pain. Persons with pain were also less likely to be employed. These findings are consistent with previous research that shows that pain is common in MS, that it is severe in a substantial subset of these individuals and has the potential to negatively impact physical and psychosocial functioning over and above the effects of MS itself.

This article highlights the significant prevalence and impact of pain in persons who have disabilities and points to the need for additional research in this area. Theory-driven research examining biopsychosocial models of and treatments for chronic pain are the important next steps in this area. The extensive literature on persons in whom pain is the primary disability provides a useful basis for such research. Pain may be one of several problems facing rehabilitation professionals in their care of persons with disabilities. Nonetheless, given the suffering associated with it, pain warrants careful assessment and, as indicated, intervention.

Objective: To examine the types and relative frequency of treatments used for lower-limb phantom limb pain (PLP), including both pharmacologic and rehabilitative interventions., Design: Cross-sectional survey., Setting: Community-based survey from clinical databases., Participants: Community-based sample (N=255) of persons with lower-limb amputations., Interventions: Not applicable., Main Outcome Measures: Intensity of PLP and type and helpfulness of treatments (both past and present) used for PLP., Results: Although 72% of the sample (n=183) reported current PLP, 53% of the respondents with PLP (and 38% of those with severe PLP) had never used treatment for PLP. Those who had used treatment reported greater pain severity and interference. The most commonly used treatment modality was analgesic medication, including acetaminophen, opioids, and nonsteroidal anti-inflammatory drugs. Of the treatments surveyed, only opioids and chiropractic care were rated as moderately to extremely helpful by the majority of those who had tried them, and many pain interventions had been discontinued., Conclusions: As hypothesized, a significant proportion of persons with PLP have not used treatment for this pain, and, among those who have used pain treatments, few treatments are perceived as substantially helpful. More research is needed to identify effective management strategies for PLP and to examine further patient perceptions of pain treatment.

Unlabelled: Pain intensity is commonly measured by patient ratings on numerical rating scales (NRS). However, grouping such ratings into categories may be useful for guiding treatment decisions or interpreting clinical trial outcomes. The purpose of this study was to examine pain intensity classification in 2 samples of persons with spinal cord injuries (SCI) and chronic pain. The first sample (n = 307) rated the average intensity and activity interference of pain in general, and the second sample (n = 174) rated their worst pain problem. Pain intensity was categorized as mild, moderate, or severe using 4 possible classification systems; analyses were performed to determine the classification system that best distinguished the pain intensity groups in terms of activity interference. In both samples, the optimal mild/moderate boundary was lower (mild = 1-3 on a 0-10 NRS scale) than that reported previously for individuals with other pain problems. The possibility that pain may interfere with activity at lower levels for individuals with SCI requires further exploration. The moderate/severe boundary suggested by previous research was confirmed in only one of the samples. Implications for the assessment of pain intensity and functioning in persons with SCI and pain are discussed., Perspective: Although pain in individuals with SCI is common, more research is needed regarding its characteristics and treatment. This study sought to develop an empirically based classification system for mild, moderate, and severe pain that could be useful for applying clinical treatment guidelines and for interpreting the results of much-needed clinical trials.

Objective: To examine the clinical significance of changes in chronic pain in 2 disability groups: spinal cord injury and lower limb amputation., Methods: A reanalysis of 2 controlled clinical trials for pain in persons with disabilities. Eighty-two persons with spinal cord injuries and 34 persons with amputations provided pretreatment and posttreatment ratings of pain intensity on 0 to 10 numerical rating scales. After treatment, participants also rated the meaningfulness of any changes in pain they experienced., Results: An average decrease of 1.80 points on the 0 to 10 numerical rating scales and percent decreases of about 36% corresponded to reports of a meaningful change in pain. There was no significant difference between samples, and also no differences due to gender or treatment condition. Age and pretreatment pain, however, were associated with the amount of pain decrease rated as meaningful. The change in pain intensity rated as meaningful was greater for older participants and participants with higher levels of pretreatment pain. Consistent with previous research, percent change scores were less biased by pretreatment pain than were absolute change scores., Discussion: These findings are generally consistent with similar findings in other pain populations, and, in light of previous research, support an approximate 33% decrease in pain as a reasonable standard for meaningful change across chronic pain conditions. Percent change scores may be more useful for comparing the effects of pain treatments across samples or conditions because they are less biased by pretreatment pain level.

Twenty-four adults with phantom limb pain (PLP) and/or residual limb pain (RLP) participated in a double-blind crossover trial. Participants were randomly assigned to receive gabapentin or placebo and later crossed over to the other treatment, with a 5-week washout interval in which they did not receive medication. Gabapentin was titrated from 300 mg to the maximum dose of 3,600 mg. Measures of pain intensity, pain interference, depression, life satisfaction, and functioning were collected throughout the study. Analyses revealed no significant group differences in pre- to posttreatment change scores on any of the outcome measures. More than half of the participants reported a meaningful decrease in pain during the gabapentin phase compared with about one-fifth who reported a meaningful decrease in pain during the placebo phase. In this trial, gabapentin did not substantially affect pain. More research on the efficacy of gabapentin to treat chronic PLP and RLP is needed.