Minnesota Alliance for Nursing Education (MANE): A Unique Multi-institutional Approach to Preparing Nurses for the Future.

AIM: The purpose of this article is to inform nurse educators of an innovative and transformative approach to advancing nursing education through the creation of the Minnesota Alliance for Nursing Education (MANE). BACKGROUND: MANE was formed to answer national appeals to transform nursing education and demands by health care organizations for a more highly educated nursing workforce. METHOD: An action plan was developed with the Minnesota Action Coalition to create a dual admission community college and university eight-semester baccalaureate curriculum that students could complete seamlessly in four years. RESULTS: Admissions to the program have been robust, matriculation rates to upper division course work have exceeded initial goals, and diversity of students is increasing. CONCLUSION: Measures to date show that MANE is a viable and successful program that is surpassing its initial goals.

Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure.

BACKGROUND: Health-related quality of life (HRQOL) is a major clinical outcome for heart failure (HF) patients. We aimed to determine the frequency, durability, and prognostic significance of improved HRQOL after hospitalization for decompensated HF. METHODS AND RESULTS: We analyzed HRQOL, measured serially using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), for 425 patients who survived to discharge in a multicenter randomized clinical trial of pulmonary artery catheter versus clinical assessment to guide therapy for patients with advanced HF. All patients enrolled had 1 or more prior HF hospitalizations or chronic high diuretic doses and 1 or more symptom and 1 sign of fluid overload at admission. Improvement, defined as a decrease of more than 5 points in MLHFQ total score, occurred in 68% of patients by 1 month and stabilized. The degree of 1-month improvement differed (P < .0001 group x time interaction) between 6-month survivors and non-survivors. In a Cox regression model, after adjustment for traditional risk factors for HF morbidity and mortality, improvement in HRQOL by 1 month compared to worsening at 1 month or no change predicted time to subsequent event-free survival (P=.013). CONCLUSIONS: In patients hospitalized with severe HF decompensation, HRQOL is seriously impaired but improves substantially within 1 month for most patients and remains improved for 6 months. Patients for whom HRQOL does not improve by 1 month after hospital admission merit specific attention both to improve HRQOL and to address high risk for poor event-free survival.

The effects of isolated telephone interventions on glycemic control in type 2 diabetes: a literature review.

A systematic literature review of studies published between 1990 and 2008 was conducted to evaluate the impact of isolated telephone interventions on glycemic control in adults with type 2 diabetes. Eight randomized controlled trials met the inclusion criteria. Overall, the interventions had mixed effects on glycemic control, suggesting further research is needed in this area. Current evidence does not support isolated telephone interventions to improve glycemic control in type 2 diabetes mellitus; well-designed studies to establish the effectiveness of this potentially cost-effective modality can be an important step in addressing the diabetes epidemic.

A randomized controlled trial of an automated telephone intervention to improve glycemic control in type 2 diabetes.

A randomized controlled trial was conducted to evaluate the impact of an automated telephone intervention on glycemic control in patients with type 2 diabetes. One hundred twenty participants were randomly assigned to a treatment group that received a daily, automated telephone message regarding diabetes or to a control group that received usual care. The treatment group demonstrated a significant improvement in the frequency of self-monitoring of blood glucose levels compared with the control group (P < .001). A favorable trend in positive attitudes toward diabetes and a reduction in perceived monitoring and exercise barriers were seen in the intervention group compared with the control group.

Genomic profiling of the human heart before and after mechanical support with a ventricular assist device reveals alterations in vascular signaling networks.

Mechanical unloading of the heart with a left ventricular assist device (LVAD) significantly decreases mortality in patients with heart failure. Moreover, it provides a human model to define the critical regulatory genes governing myocardial remodeling in response to significant reductions in wall stress. Statistical analysis of a gene expression library of 19 paired human heart samples harvested at the time of LVAD implant and again at explant revealed a set of 22 genes that were downregulated and 85 genes that were upregulated in response to mechanical unloading with a false discovery rate of less than 1%. The analysis revealed a high percentage of genes involved in the regulation of vascular networks including neuropilin-1 (a VEGF receptor), FGF9, Sprouty1, stromal-derived factor 1, and endomucin. Taken together these findings suggest that mechanical unloading alters the regulation of vascular organization and migration in the heart. In addition to vascular signaling networks, GATA-4 binding protein, a critical mediator of myocyte hypertrophy, was significantly downregulated following mechanical unloading. In summary, these findings may have important implications for defining the role of mechanical stretch and load on autocrine/paracrine signals directing vascular organization in the failing human heart and the role of GATA-4 in orchestrating reverse myocardial remodeling. This unbiased gene discovery approach in paired human heart samples has the potential to provide critical clues to the next generation of therapeutic treatments aimed at heart failure.