Acute serum protein and cytokine response of single dose of prednisone in adult volunteers.

Pharmacological glucocorticoids are the most prescribed anti-inflammatory medications, and are chemical variants of cortisol, the circadian and stress hormone. Both endogenous and pharmacological glucocorticoids bind the glucocorticoid receptor (NR3C1) with high affinity, and both then bind downstream gene promoter elements (GRE) to drive positive gene transcription of many proteins. Glucocorticoid/GR complexes also bind distinct negative gene promoter elements (nGRE) to inhibit expression of genes involved in NF-κB innate immunity signaling. We sought to define the acute response of a single dose of prednisone (0.2 mg/kg) in young adult volunteers, with blood samples taken at baseline, 2, 3, 4 and 6 h post-oral dose. To control for circadian morning cortisol hitting the same molecular pathways, a day of blood draws was done without oral prednisone (same time of day), one day prior to drug day. Serum samples were processed for steroid hormone profiles (mass spectrometry; 9 steroidal hormones), proteomics (SOMAscan aptamer panels, 1,305 proteins), and inflammatory markers (Meso Scale Discovery; 10 pro-inflammatory cytokines). The pharmacological effect of the prednisone dose was shown by significant declines of adrenal steroids by 3 h after dosing. IL-10 showed drug-related increase to 4 hrs, then decrease to 6 hrs. IL-8 showed drug-related decrease in serum by 4 h, consistent with direct negative action of GR/ligand on IL-8 gene promoter. Proteomics data showed beta-2 microglobulin, TNFSF15, TSH, CST3, NBL1 to show time-related decreases with prednisone, while CXCL13 showed increases, although these require validation. In summary, a single low dose of prednisone leads to broad suppression of the adrenal axis within 3 h, and down-regulation of inflammatory serum proteins by 6 h.

Ushering in a New Era for King's Conceptual System and Theory of Goal Attainment.

The COVID-19 pandemic has ushered in a new era for nurses and healthcare. King's conceptual framework continues to provide a practical theoretical underpinning for nurse-client interactions in virtual care spaces that are now a pervasive part of the interacting systems framework. The author in this article discusses the current applications and future opportunities for applications of King's work in practice, education, and research.

Leadership Opportunities for Nurses in Telehealth: A King Perspective.

Advanced practice registered nurses (APRNs) are in an excellent position to provide leadership for advancing telehealth initiative. King's social system concepts of role, status, authority, power, and decision-making may be explored in this context. The authors of this article provide insight into the leadership opportunities in telehealth that exist for APRNs in current healthcare systems through a King perspective. The authors discuss some of the major challenges for APRNs in telehealth and how leadership may overcome some of those challenges.

Nursing Theory in Virtual Care.

Individuals are increasingly seeking care in virtual care environments as the healthcare system evolves. Nurses are well poised to enhance their scope of practice into these environments that can transcend time, space, and location. The author discusses both how virtual care environments are seen in today's healthcare systems and how nursing theory and research will contribute to enhancing quality care for individuals in virtual care environments.

Attaining Mutual Goals in Telehealth Encounters: Utilizing King's Framework for Telenursing Practice.

Access to essential health-promoting nursing care is increasingly facilitated through the expanding scope and capabilities provided through the utilization of telehealth technologies. Telehealth technologies facilitate the nursing process with clients at a distance in multiple ways, such as video conferencing, video conferencing with peripheral diagnostic tools, and store and forward modalities. Nursing care needs to remain the focus of care, but technology is a useful ancillary tool to help clients achieve health outcomes. The authors of this article discuss nursing practice and the use of telehealth technology and how King's concepts and theory of goal attainment can be used as a guiding framework.

Enhancing Telehealth Education in Nursing: Applying King's Conceptual Framework and Theory of Goal Attainment.

Telehealth technologies are increasingly used in the provision of nursing care to clients and populations. The education of nurses must include content and practice with telehealth technologies. The authors of this article discuss how one school of nursing has infused telehealth content and resources into undergraduate and graduate curricula using King's conceptual system and theory of goal attainment as a guide.

A Phenomenologic Study of Family Caregivers of Patients With Head and Neck Cancers.

PURPOSE/OBJECTIVES: To describe and understand the lived experience of family caregivers of patients with head and neck cancers (HNCs). RESEARCH APPROACH: Phenomenology using van Manen's human science approach
. SETTING: Two hospital systems providing regional cancer care in upstate New York. 
. PARTICIPANTS: Nine family caregivers of patients with HNCs who had completed treatment
. METHODOLOGIC APPROACH: Qualitative analysis of semi-structured, conversational interviews about the lived experience of family caregivers. FINDINGS: Five major themes emerged related to the lived experiences of this sample of caregivers. CONCLUSIONS: Family caregivers of patients with HNCs play a fundamental role in the post-treatment phase of care, including meeting specific physical and psychosocial needs. Further investigation should explore the relationship between information needs and the experience of vigilance and fear. INTERPRETATION: Nurses must include caregivers in physical and psychosocial plans of care. Balancing and meeting information needs of caregivers to avoid undue emotional stress and recognizing their support needs are valuable components of care.