bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of Consensus‐Based Clinical Guidelines in Critical Care Through Standardized Nursing Language
Authors: Morales Jose Miguel , Torres A. , Muñoz F. , León J. , Miralles L. 
Published: August 2004

PURPOSETo develop regional clinical practice guidelines for nurse decision making in critical care settings.METHODSIn the health department of the Andalusian region in Spain, a critical care nursing expert panel was created to develop clinical practice guidelines. A total of 14 critical care nurses (scholars, clinical nurses, managers) comprised the panel. The first obstacle was a lack of systematic reviews or clinical trials about these concerns. Therefore, the first version of the guidelines was consensus based. In order to strengthen the guidelines' structure, standardized nursing language systems and nursing process were employed as a conceptual frame. Problem identification using collaborative problems or nursing diagnoses (NANDA), literature review, recommendations presented by NIC labels, peer review of the recommendations, drafting the guidelines, and second peer review by the expert panel members resulted in the final version of each guideline.FINDINGSA consensus‐based clinical practice guideline manual prepared for critical care nursing in the health system in the southern region of Spain covered prehospital emergency care, health department services, and ICUs. These guidelines contain nurse‐sensitive situations and are nurse oriented, using standardized nursing languages for clinical decision making.CONCLUSIONSEvidence‐based clinical practice guidelines are needed in nursing decision making, but there is a lack of solid research‐based results for developing recommendations. The use of standardized nursing language for guidelines development decreases the variability of clinical practice, fosters homogeneity in nurses' problem‐solving schemes, and opens new research areas in clinical effectiveness. In future guidelines reviews, NOC and available systematic review‐based recommendations will be included. More quality research is needed in critically ill patient human responses.
Linking Nursing Outcomes To Long‐Term Care Quality Indicators
Authors: Nielsen Theresa , Schutte Sheryl 
Published: August 2004

BACKGROUNDThe Alverno is a 135‐bed long‐term care facility. All long‐term care facilities are required by the Center for Medicare and Medicaid Services to perform a common assessment using the Minimum Data Set format. This assessment can trigger up to 24 quality indicators that directly affect resident care and quality of life. Each facility average is compared with the state average for that quality improvement. A facility percentile is derived from this comparison. High percentiles are indicative of problems.MAIN CONTENT POINTSThe 24 quality indicators triggered as part of the assessment provided a focal point for state surveys as well as individual facility quality committees. Nursing outcomes using NOC labels can be linked to these quality indicators, but the number is large.CONCLUSIONSA large number of NOC labels, although appropriate in acute care, cannot be implemented in long‐term care settings without some modification.
A Proposed Framework of Reference for the Evaluation of Nursing Information Systems
Authors: Mathieu Luc 
Published: August 2004

PURPOSETo develop, implement, and evaluate a clinical knowledgeñbased nursing information system (NIS) to assist nurses working in the field of geriatrics.METHODSUsing a model familiar to information systems analysis, the author proposes a model in six dimensions (the quality of the system, the quality of the information, uses for the information, user satisfaction, individual impact, and organizational impact) to measure information system success. A Delphi survey was used to identify indicators to evaluate the success of a NIS. Sixty indicators were submitted to 24 nurses working in different clinical settings from various areas of the province of Quebec. The participants were asked to give their opinion on the pertinence and the clarity of definition of the submitted indicators. To be considered, an indicator had to obtain the group's consensus (85%) regarding its pertinence and the clarity of its wording.FINDINGSThe Delphi Group reached consensus on 50 indicators divided amongst the six dimensions. The choice of various indicators to evaluate an NIS will depend on its very nature and on the concerns for assessment. The results of this work led us to propose a framework of reference for the evaluation of nursing information systems. The chosen indicators constitute a set that can be used to evaluate the success of other NISs.CONCLUSIONSFuture research is needed to identify the best methods to assess the chosen indicators and clarify the definition of those indicators that have been judged pertinent but are not clearly stated.
Women Putting Out the Fire: Using Research to Work With Women for a Healthier Tomorrow
Authors: Farren Arlene 
Published: August 2004

BACKGROUNDTobacco use by college students is high. In the 1990s, smoking rates among teenage girls rose sharply. The teenage girl smokers of the 1990s are the college‐age women smokers of today and tomorrow. Targeting women is important because their health risks due to smoking include not only the widely known risks, but also reproductive health risks. Healthy People 2010 recommendations include a 30% increase in cessation attempts and a 15%–30% reduction in smoking. AWHONN supports guidance and interventions from a healthcare professional to address prevention, cessation, and follow‐up for women of all ages.MAIN CONTENT POINTSImplementing an evidence based program to prevent smoking, assist with cessation, and provide relapse prevention in college‐aged women can enhance existing college programs in smoking cessation. NANDA, NIC, and NOC classification linkages and gold standard guidelines are used in the clinical, clientcentered strategies.CONCLUSIONSThe college setting is uniquely placed to provide health‐promoting behaviors to young adult women. Nursing professionals, using discipline‐guided classifications, can make a contribution to women's health by using research‐based interventions and outcomes to prevent smoking, assist with cessation, and provide follow‐up to prevent relapse. Nursing students, advanced practice nurses, and nursing faculty can partner with colleagues in the college health and wellness center programs using the best evidence to help women quit smoking.
Translating Nursing Language Into Lay Language
Authors: Thorarinsdottir Kristín 
Published: August 2004

PURPOSETo explore the meaning that patients undergoing total hip replacement ascribe to the lived experience of retaining and reading their nursing care plan in lay language before and after the surgery.METHODA standardized nursing care plan for patients undergoing total hip replacement was written in lay language and used as a perioperative teaching material. Qualitative data were collected with in‐depth interviews and analysed. The sample consisted of 6 patients undergoing total hip replacement.FINDINGSThe overriding theme, acquired knowledge, was the main meaning that participants ascribed to their experience of the care plan. Other issues or major themes that were of particular importance to participants were that the text of the care plan was understandable and meaningful, the care plan had empowering effects, and revision of the care plan was recommended. In addition, general satisfaction of the healthcare service was a significant part of the participants' experience.CONCLUSIONSPatients can acquire empowering knowledge from a patient version of their nursing care plan. Patient versions of care plans for total knee and hip replacements have been implemented in the hospital.
NIC: An Orientation Program for Long‐Term Care
Authors: O'Gara Joanne 
Published: August 2004

BACKGROUNDAn organized, comprehensive orientation program enables new nurses to adjust to their new work environment and feel a part of the organization. The orientation program at the Alverno Health Care Facility, a 135‐bed long‐term care facility in Clinton, IA, was based on state and federal requirements and job descriptions. The familiarity of having included NANDA, NIC, and NOC in resident care plans for years prompted the integration of standardized nursing language into the existing orientation.MAIN CONTENT POINTSSuccessful implementation of NIC requires organizational commitment. The revamping of the orientation began with meetings of the nursing management team consisting of the chief executive officer, nursing supervisors, infection control nurse, continuous quality improvement nurse, and inservice director.During the initial phase of development, the NIC interventions most applicable to long‐term care were identified. From this list, each team member selected 25 interventions based on regulations, frequency, and high risk. These interventions were compared to the topics in the existing orientation program. Job descriptions were reviewed for key roles to identify topics that correlated to the interventions. Data were queried from the care plans to determine the frequency of nursing diagnoses, interventions, and outcomes. In addition, federal requirements were itemized with the corresponding intervention identified for each area.The team collated the data from the existing orientation, job descriptions, care plans, and federal regulations to select 25 care competencies to include in the nursing orientation program. The team agreed to designate seven activities most applicable to long‐term care for each intervention. Staff nurses were included in the selection process. Some activities listed in the third edition of NIC were altered to be more specific to long‐term care. The results were compiled and used as the foundation for the nurses' orientation and performance evaluation.The orientation program was designed to be completed within 4 weeks, with week 1 addressing federal and OSHA requirements. A preceptor was assigned to each new nurse to enhance the learning opportunities. Various methods of presentation were constructed using the principles of adult learning to foster interest and retention of information. Classes were interspersed with clinical orientation.CONCLUSIONSIncluding NIC interventions in the nursing orientation program provided an opportunity to support standardized nursing language, conveyed a sense of teamwork and commitment to the organization, and defined expectations in the standards of care. The general orientation for all departments was enhanced by incorporating NIC into required topics of safety, infection control, abuse prevention, body mechanics, resident rights, and dementia management. Further, the NIC‐based orientation was used as a basis for the hiring process.
NIC Use by Urologic Nurses in Iceland
Authors: Jonsdottir Anna , Thoroddsen Asta 
Published: August 2004

PURPOSE To investigate which NIC interventions are used by nurses in the urologic unit in order to establish a nursing documentation system for an electronic patient record.METHODS The NIC Use Survey questionnaire, developed by the Iowa Intervention Project Team, had been translated into Icelandic by a group of nurses within the Directorate of Health. Some changes were made to the questionnaire in concordance with the up‐to‐date version of NIC; it included 450 intervention labels and their definitions grouped into 27 classes of interventions according to the NIC class structure. Respondents (a convenience sample of 19 nurses who worked in the urological units) were asked to rate how often they performed each intervention. Six responses are possible: never, rarely, about once a month, about once a week, about once a day, or several times a day.FINDINGS The respondents were 15 nurses (response rate 79%). Most of the subjects had >5 years of experience in nursing (93%) and most had >5 years of experience in urologic nursing (73%).On the urologic unit, 299 (66%) of the 450 interventions were used rarely or more often by >50% of the nurses. Of those 299 interventions, 153 (34%) were used monthly or more often by more than 50% of the nurses; 151 interventions (34%) were never used by more than 70% of the nurses, and of these interventions 71 (15%) were never used by 100% of the urologic nurses.CONCLUSIONS The NIC Use Survey was a useful tool to determine which interventions should be included in the computer software of specialities. However, the interventions that are most frequently used by urologic nurses cannot be called core interventions because they include a lot of common nursing interventions and therefore do not define the nature of the speciality.
Genotype and Phenotype Patterns of Human Immunodeficiency Virus Type 1 Resistance to Enfuvirtide during Long-Term Treatment
Authors: Menzo Stefano , Castagna Antonella , Monachetti Alessia , Hasson Hamid , Danise Anna , Carini Elisabetta , Bagnarelli Patrizia , Lazzarin Adriano , Clementi Massimo 
Published: August 2004

ABSTRACT

The human immunodeficiency virus type 1 (HIV-1) fusion inhibitor enfuvirtide has recently been introduced into clinical practice and has exhibited efficient anti-HIV-1 activity in combination with other antiretroviral agents. In the present study, we addressed the effect of long-term treatment with enfuvirtide on the intrahost evolution of HIV-1. The genotype and phenotype patterns and the relative replication capacity (rRC) of enfuvirtide-resistant HIV-1 mutants were evaluated in samples from 11 subjects (7 virological nonresponders and 4 responders) who received the compound for more than 1 year in combination with different regimens. Selection of one or more mutations clustering in a sequence (amino acids 36 to 45) of the gp41 N-terminal heptad repeat was observed in samples from the seven virological nonresponders but not in those from responders. In two subjects who discontinued enfuvirtide, reversion of the resistant genotype was detected within 3 months. Recombinant clones bearing mutated gp41 sequences displayed reduced susceptibilities to enfuvirtide, with the 50% inhibitory concentrations (IC
50
s) ranging from 0.6 to 12.8 μg/ml, whereas the IC
50
for isolates with baseline sequences was 0.013 ± 0.010 μg/ml. Interestingly, long-term monitoring of resistant variants provided evidence that ongoing adaptation to the drug is paralleled by phenotypic changes. A limited drop in the rRC in the absence of drug was observed for clones from four of the seven nonresponders bearing mutations associated with resistance. Overall, the data indicate that the different genotype patterns associated with a detectable degree of HIV-1 resistance to enfuvirtide generated during long-term treatments are characterized by a substantially low genetic barrier, possible ongoing adaptation with increased degrees of resistance, and limited influence on the viral rRC.
De Novo Design of Potent Antimicrobial Peptides
Authors: Frecer V. , Ho B. , Ding J. L. 
Published: August 2004

ABSTRACT
Lipopolysaccharide (LPS), shed by gram-negative bacteria during infection and antimicrobial therapy, may lead to lethal endotoxic shock syndrome. A rational design strategy based on the presumed mechanism of antibacterial effect was adopted to design cationic antimicrobial peptides capable of binding to LPS through tandemly repeated sequences of alternating cationic and nonpolar residues. The peptides were designed to achieve enhanced antimicrobial potency due to initial bacterial membrane binding with a reduced risk of endotoxic shock. The peptides designed displayed binding affinities to LPS and lipid A (LA) in the low micromolar range and by molecular modeling were predicted to form amphipathic β-hairpin-like structures when they bind to LPS or LA. They also exhibited strong effects against gram-negative bacteria, with MICs in the nanomolar range, and low cytotoxic and hemolytic activities at concentrations significantly exceeding their MICs. Quantitative structure-activity relationship (QSAR) analysis of peptide sequences and their antimicrobial, cytotoxic, and hemolytic activities revealed that site-directed substitutions of residues in the hydrophobic face of the amphipathic peptides with less lipophilic residues selectively decrease the hemolytic effect without significantly affecting the antimicrobial or cytotoxic activity. On the other hand, the antimicrobial effect can be enhanced by substitutions in the polar face with more polar residues, which increase the amphipathicity of the peptide. On the basis of the QSARs, new analogs that have strong antimicrobial effects but that lack hemolytic activity can be proposed. The findings highlight the importance of peptide amphipathicity and allow a rational method that can be used to dissociate the antimicrobial and hemolytic effects of cationic peptides, which have potent antimicrobial properties, to be proposed.
Impact of Alpha Interferon and Ribavirin on the Function of Maturing Dendritic Cells
Authors: Barnes Eleanor , Salio Mariolina , Cerundolo Vincenzo , Medlin Joanne , Murphy Shona , Dusheiko Geoffrey , Klenerman Paul 
Published: August 2004

ABSTRACTAlpha interferon and ribavirin are required in combination to achieve a sustained virological response in the treatment of hepatitis C virus (HCV) infection. Alpha interferon has direct antiviral activity and also enhances HCV-specific T-cell responses. Ribavirin has little direct activity against HCV but reduces hepatic inflammation. It is therefore likely that these drugs in combination have hitherto unidentified immunological effects. In the present study we investigated the effects of alpha interferon and ribavirin on dendritic cell (DC) maturation and cytokine production induced by double-stranded RNA in vitro. Alpha interferon alone enhanced the expression of HLA class I, HLA class II, and CD86 on immature DCs but did not stimulate full DC maturation, which requires the expression of CD83. Alpha interferon enhanced the production of interleukin 12 p70 [IL-12(p70)] and tumor necrosis factor alpha (TNF-α) but had no effect on IL-10 production. In contrast, ribavirin at physiological doses had no effect on DC maturation but markedly suppressed the production of TNF-α, IL-10, and IL-12(p70). The suppression of cytokines by ribavirin cannot be explained by the induction of DC apoptosis or cell death. Quantitative PCR confirmed that cytokine suppression occurs at the level of mRNA. The suppression of IL-12(p70) and TNF-α in maturing DCs may explain the reduction in hepatic inflammation observed during ribavirin monotherapy. Combination alpha interferon-ribavirin therapy may alter the cytokine profile of maturing DCs overall by suppressing IL-10 production but maintaining IL-12(p70) and TNF-α production, a pattern that would favor viral elimination through downstream effects on T cells.
Paradoxical Effect of Caspofungin: Reduced Activity against
Candida albicans
at High Drug Concentrations
Authors: Stevens David A. , Espiritu Marife , Parmar Rachana 
Published: August 2004

ABSTRACT

Resistance problems with caspofungin, an echinocandin inhibitor of fungal cell wall glucan synthesis, have been rare. We noted paradoxical turbid growth of
Candida albicans
isolates in broth in some high (supra-MIC) concentrations. Among isolates submitted for susceptibility testing and screened at drug concentrations up to 12.5 μg/ml, the frequency was 16%. Analysis of the turbid growth indicated slowing of growth in the presence of drug but with numbers of CFU up to 72% those of drug-free controls. Clearing of growth again by the highest drug concentrations produced a quadriphasic pattern in a tube dilution series. Cells growing at high drug concentrations were not resistant on retesting but showed the paradoxical effect of the parent. Among a selected series of isolates tested at concentrations up to 50 μg/ml, an additional 53% showed a “mini-paradoxical effect”: no turbid growth but incomplete killing at high concentrations (supra-minimum fungicidal concentration). These effects were reproducible; medium dependent in extent; noted in macro- and microdilution, in the presence or absence of serum, and on agar containing drug (but not when drug concentrations were not constant, as in agar diffusion); not seen with other echinocandins and less commonly in other
Candida
species; and not due to destruction of drug in tubes showing the effect. Cooperative enhancement of inhibition by a second drug could eradicate the effect. We postulate that high drug concentrations derepress or activate resistance mechanisms. The abilities of subpopulations to survive at high drug concentrations could have in vivo consequences.
Incidence of Antibiotic Resistance inCampylobacter jejuniIsolated in Alberta, Canada, from 1999 to 2002, with Special Reference totet(O)-Mediated Tetracycline Resistance
Authors: Gibreel Amera , Tracz Dobryan M. , Nonaka Lisa , Ngo Trinh M. , Connell Sean R. , Taylor Diane E. 
Published: August 2004

ABSTRACTOf 203 human clinical isolates ofCampylobacter jejunifrom Alberta, Canada (1999 to 2002), 101 isolates (50%) were resistant to at least 64 μg of tetracycline/ml, with four isolates exhibiting higher levels of tetracycline resistance (512 μg/ml). In total, the MICs for 37% of tetracycline-resistant isolates (256 to 512 μg/ml) were higher than those previously reported inC. jejuni(64 to 128 μg/ml). In the tetracycline-resistant clinical isolates, 67% contained plasmids and all contained thetet(O) gene. Four isolates resistant to high levels of tetracycline (MIC = 512 μg/ml) contained plasmids carrying thetet(O) gene, which could be transferred to other isolates ofC. jejuni. The tetracycline MICs for transconjugants were comparable to those of the donors. Cloning oftet(O) from the four high-level tetracycline-resistant isolates conferred an MIC of 32 μg/ml forEscherichia coliDH5α. In contrast, transfer to a strain ofC. jejuniby using mobilization conferred an MIC of 128 μg/ml. DNA sequence analysis determined that thetet(O) genes encoding lower MICs (64 to 128 μg/ml) were identical to one other, although thetet(O) genes encoding a 512-μg/ml MIC demonstrated several nucleotide substitutions. The quinolone resistance determining region of four ciprofloxacin-resistant isolates (2%) was analyzed, and resistance was associated with a chromosomal mutation in thegyrAgene resulting in a Thr-86-Ile substitution. In addition, six kanamycin-resistant isolates contained large plasmids that carry theaphA-3marker coding for 3′-aminoglycoside phosphotransferase. Resistance to erythromycin was not detected in 203 isolates. In general, resistance to most antibiotics inC. jejuniremains low, except for resistance to tetracycline, which has increased from about 8 to 50% over the past 20 years.