Integrated older people care and advanced practice nursing: an evidence-based review.

AIM: To critically appraise and synthesize evidence of integrated care stemming from advanced practice nursing in elderly primary care settings throughout the United States and Thailand. BACKGROUND: Advanced practice nurses are key to accelerating integrated elderly care in the community. Yet, their scope and capacity vary greatly across countries, making impact measurement highly challenging. METHODS: A systematic search of PubMed, CINAHL, Scopus and ThaiJo databases was performed. Full-text articles in English or Thai language were reviewed using an inductive thematic approach from the integrated people-centred Health Services framework, adopted by the World Health Organization. RESULTS: A total of 42 articles were appraised according to framework strategies: (1) people and community empowerment/engagement; (2) governance and accountability strengthening; (3) model of care reorientation; (4) service coordination; and (5) enabling environment creation. Collaborative roles and empowerment of older people were associated with higher quality of care. Thai nurses empowered individuals through community networks and resources, incorporating care models (strategy 1). In contrast, US nurses adopted a quality improvement and safety approach, incorporating technology into nursing interventions (strategy 5). CONCLUSION: Advanced practice nurses employ an array of strategies and approaches in caring for older people. Although their role varies from mostly substitute (US) to supplemental (Thailand), nurses in both countries contribute towards integrated person-centred care. IMPLICATION FOR NURSING PRACTICE AND NURSING POLICY: Preparing advanced practice nurses to work in the community is a prerequisite for meeting ageing population health needs in a sustainable manner. Education, professional development and leadership training opportunities should focus on capacity building in: a) strengthening mutual accountability, b) reorienting the work environment through innovative care models and c) coordinating services through partnerships to achieve universal health and ensure healthy ageing.

Sustaining global partnerships for simulation integration: lessons from the field.

AIM: A reciprocal partnership between two World Health Organization Collaborating Centers in the Americas region aimed to strengthen nursing and midwifery education through innovative integration of high-fidelity simulation. METHODS/IMPLEMENTATION: Immersion of a visiting scholar in six-week training within a North American nursing school (host) solidified simulation champion designation, upon return at the home institution. Next, two expert nursing faculty implemented a train-the-trainer simulation course on-site. Following evaluation and virtual debriefing, a midwifery faculty visited the host institution for second-round training. CONCLUSION: This ongoing program targets faculty development needs through a strong academic partnership, built upon global awareness and sustainable engagement.

Nutrigenetic genotyping study in relation to Sleep Apnea Clinical Score.

BACKGROUND: Conflicting results regarding associations between single nucleotide polymorphisms (SNPs) in IRS1, ACE, APOE, PPARG, MTHFR, 5HT2AR, BDNF, and FTO genes and obstructive sleep apnea have been reported in previous studies. OBJECTIVE: To assess pleiotropic associations between these gene polymorphisms that are commonly being studied in a nutrigenetic test and sleep apnea. METHODS: One hundred and nine subjects of Caucasian origin who have performed a commercially available nutrigenetic test that includes the aforementioned polymorphisms were divided into two groups depending on the results of their Sleep Apnea Clinical Score (SACS ≤ 15 or > 15). Statistical significant differences in the prevalence of the polymorphisms under study between the groups were assessed with the Chi-squared test. Possible associations of the polymorphisms with SACS and BMI were further evaluated with logistic regression analyses. RESULTS: From the polymorphisms studied, only variant rs9939609 in the FTO gene was more prevalent in people with high sleep apnea clinical score (χ2 = 7.1, P = 0.029). However, this association was attenuated after adjustment for body mass index (OR = 0.653, P = 0.178). CONCLUSION: We failed to confirm previously reported associations between the majority of the studied polymorphisms and sleep apnea. Body weight seems to be an important cofounding factor that needs to be accounted for, when genetic association studies are performed for sleep apnea.

Cell structure, stiffness and permeability of freeze-dried collagen scaffolds in dry and hydrated states.

Scaffolds for tissue engineering applications should be highly permeable to support mass transfer requirements while providing a 3-D template for the encapsulated biological cells. High porosity and cell interconnectivity result in highly compliant scaffolds. Overstraining occurs easily with such compliant materials and can produce misleading results. In this paper, the cell structure of freeze-dried collagen scaffolds, in both dry and hydrated states, was characterised using X-ray tomography and 2-photon confocal microscopy respectively. Measurements have been made of the scaffold's Young's modulus using conventional mechanical testing and a customised see-saw testing configuration. Specific permeability was measured under constant pressure gradient and compared with predictions. The collagen scaffolds investigated here have a coarse cell size (∼100-150 µm) and extensive connectivity between adjacent cells (∼10-30 µm) in both dry and hydrated states. The Young's modulus is very low, of the order of 10 kPa when dry and 1 kPa when hydrated. There is only a single previous study concerning the specific permeability of (hydrated) collagen scaffolds, despite its importance in nutrient diffusion, waste removal and cell migration. The experimentally measured value reported here (5 × 10(-)(10)m(2)) is in good agreement with predictions based on Computational Fluid Dynamics simulation and broadly consistent with the Carman-Kozeny empirical estimate. It is however about three orders of magnitude higher than the single previously-reported value and this discrepancy is attributed at least partly to the high pressure gradient imposed in the previous study. STATEMENT OF SIGNIFICANCE: The high porosity and interconnectivity of tissue engineering scaffolds result in highly compliant structures (ie large deflections under low applied loads). Characterisation is essential if these scaffolds are to be systematically optimised. Scaffold overstraining during characterisation can lead to misleading results. In this study, the stiffness (in dry and hydrated states) and specific permeability of freeze-dried collagen scaffolds have been measured using techniques customised for low stiffness structures. The scaffold cell structure is investigated using X-ray computed tomography, which has been applied previously to visualise such materials, without extracting any structural parameters or simulating fluid flow. These are carried out in this work. 2-photon confocal microscopy is used for the first time to study the structure in hydrated state.

An accelerated buoyancy adhesion assay combined with 3-D morphometric analysis for assessing osteoblast adhesion on microgrooved substrata.

An accelerated negative buoyancy method has been developed to assess cell adhesion strength. This method has been used in conjunction with 3-D morphometric analysis to understand the effects of surface topology on cell response. Aligned micro-grooved surface topographies (with a range of groove depths) were produced on stainless steel 316L substrates by laser ablation. An investigation was carried out on the effect of the micro-grooved surface topography on cell adhesion strength, cell and nucleus volumes, cell phenotypic expression and attachment patterns. Increased hydrophobicity and anisotropic wettability was observed on surfaces with deeper grooves. A reduction was noted in cell volume, projected areas and adhesion sites for deeper grooves, linked to lower cell proliferation and differentiation rates and also to reduced adhesion strength. The results suggest that the centrifugation assay combined with three-dimensional cell morphometric analysis has considerable potential for obtaining improved understanding of the cell/substrate interface.

Relationship between adiposity, adipokines, inflammatory markers and lipid profile in hemodialysis patients.

OBJECTIVES: Our aim is to study the correlations of leptin and adiponectin with inflammation markers, body composition and lipid profile in end stage renal disease (ESRD) patients. PATIENTS AND METHODS: Phase angle values and fat mass as calculated using BIA, Malnutrition-Inflammation Score (MIS), leptin, adiponectin, IL-6, IL-8 triglycerides, cholesterol and other common serum markers' concentrations were analyzed using simple and multiple linear regression models in 47 hemodialysis patients. RESULTS: In contrast to leptin, adiponectin is inversely correlated to BMI and fat mass in hemodialysis patients. Triglycerides were the only parameter that retained its statistical correlation significance with adiponectin in the multiple regression model. CONCLUSIONS: Fat mass is of important consideration when calculating adipokines levels and their possible correlations with other variables. The inverse correlation of adiponectin with triglycerides levels should be further delineated due to the important role of vascular diseases in total mortality and morbidity of ESRD patients.

In vitro osteoblast response to ferritic stainless steel fiber networks for magneto-active layers on implants.

The use of a porous coating on prosthetic components to encourage bone ingrowth is an important way of improving uncemented implant fixation. Enhanced fixation may be achieved by the use of porous magneto-active layers on the surface of prosthetic implants, which would deform elastically on application of a magnetic field, generating internal stresses within the in-growing bone. This approach requires a ferromagnetic material able to support osteoblast attachment, proliferation, differentiation, and mineralization. In this study, the human osteoblast responses to ferromagnetic 444 stainless steel networks were considered alongside those to nonmagnetic 316L (medical grade) stainless steel networks. While both networks had similar porosities, 444 networks were made from coarser fibers, resulting in larger inter-fiber spaces. The networks were analyzed for cell morphology, distribution, proliferation, and differentiation, extracellular matrix production and the formation of mineralized nodules. Cell culture was performed in both the presence of osteogenic supplements, to encourage cell differentiation, and in their absence. It was found that fiber size affected osteoblast morphology, cytoskeleton organization and proliferation at the early stages of culture. The larger inter-fiber spaces in the 444 networks resulted in better spatial distribution of the extracellular matrix. The addition of osteogenic supplements enhanced cell differentiation and reduced cell proliferation thereby preventing the differences in proliferation observed in the absence of osteogenic supplements. The results demonstrated that 444 networks elicited favorable responses from human osteoblasts, and thus show potential for use as magnetically active porous coatings for advanced bone implant applications.

Cell adhesion to plasma electrolytic oxidation (PEO) titania coatings, assessed using a centrifuging technique.

The adhesion of bovine chondrocytes and human osteoblasts to three titania-based coatings, formed by plasma electrolytic oxidation (PEO), was compared to that on uncoated Ti-6Al-4V substrates, and some comparisons were also made with plasma sprayed hydroxyapatite (HA) coatings. This was done using a centrifuge, with accelerations of up to 160,000 g, so as to induce buoyancy forces that created normal or shear stresses at the interface. It is shown that, on all surfaces, it was easier to remove cells under normal loading than under shear loading. Cell adhesion to the PEO coatings was stronger than that on Ti-6Al-4V and similar to that on HA. Cell proliferation rates were relatively high on one of the PEO coatings, which was virtually free of aluminium, but low on the other two, which contained significant levels of aluminium. It is concluded that the Al-free PEO coating offers promise for application to prosthetic implants.

Quality of nutritional information on the Internet in health and disease.

BACKGROUND: Quality assessment of nutritional information on the internet may prove vital prior to providing public guidance on searching relative information. METHODS: The most popular web sites on four different topics ("Mediterranean diet", "sports nutrition", "nutrition, dysphagia and children" and "herbs and common cold") were assessed with the use of two validated questionnaires (EQIP and DISCERN). RESULTS: Medical categories produced significantly lower total quality scores when compared to "Mediterranean diet" and "sports nutrition" categories. (F=7.189, P<0.001). Commercial web pages had a significantly lower credibility score compared to institutional and other web page types (H=17.987, P<0.001). Ranking order of each web page was related to its total quality score (P=0.04) but not to its credibility (P=0.241). CONCLUSIONS: Monitoring the accuracy, comprehensiveness and consistency of health-related information on the internet is an important public health issue since there are popular web pages that are regarded as of high quality but they do not always provide reliable information. Health professionals and especially dieticians should provide consumer training on how to search for and appraise nutritional information from the internet.

Primary health care nursing staff in Crete: an emerging profile.

BACKGROUND: In 2001, the newly established Regional Health and Welfare System of Crete commissioned the first needs' assessment study of nursing personnel employed in the public sector of primary health care (PHC). AIM: To capture the profile and professional needs of nursing staff working in Health Centers throughout the island of Crete and explore variations in nursing practice by educational preparation. METHODS: A newly developed, psychometrically tested questionnaire, was administered to all nursing staff in 14 rural Health Centers. FINDINGS: Vacancy rates are high, indicating a serious staffing deficit. The type of degree earned (2-year vs. 3 or 4-year program) does not differentiate nursing practice, with only two exceptions (obtaining a patient's history and counselling patients). The majority of respondents assess their existing knowledge and skills as 'adequate' while indicating a strong desire for continuing education. Job satisfaction is high in terms of interactions with clients and community recognition, while it is rated 'low' in terms of daily interactions with colleagues and support from work environment. CONCLUSION: Cretan nursing staff in PHC operate within a restricted and task-orientated framework. Their educational preparation has little effect in practice role variations and professional needs. The Regional Health and Welfare System of Crete should address daily supervision and support issues, on-the-job training, continuing education needs, while taking immediate action to avoid potential turnover of existing staff and to aggressively recruit young, qualified nursing staff who will choose a career in PHC nursing.

Porous materials for thermal management under extreme conditions.

A brief analysis is presented of how heat transfer takes place in porous materials of various types. The emphasis is on materials able to withstand extremes of temperature, gas pressure, irradiation, etc. i.e. metals and ceramics, rather than polymers. A primary aim is commonly to maximize either the thermal resistance (i.e. provide insulation) or the rate of thermal equilibration between the material and a fluid passing through it (i.e. to facilitate heat exchange). The main structural characteristics concern porosity (void content), anisotropy, pore connectivity and scale. The effect of scale is complex, since the permeability decreases as the structure is refined, but the interfacial area for fluid-solid heat exchange is, thereby, raised. The durability of the pore structure may also be an issue, with a possible disadvantage of finer scale structures being poor microstructural stability under service conditions. Finally, good mechanical properties may be required, since the development of thermal gradients, high fluid fluxes, etc. can generate substantial levels of stress. There are, thus, some complex interplays between service conditions, pore architecture/scale, fluid permeation characteristics, convective heat flow, thermal conduction and radiative heat transfer. Such interplays are illustrated with reference to three examples: (i) a thermal barrier coating in a gas turbine engine; (ii) a Space Shuttle tile; and (iii) a Stirling engine heat exchanger. Highly porous, permeable materials are often made by bonding fibres together into a network structure and much of the analysis presented here is oriented towards such materials.