Student-oriented learning outlines: a valuable supplement to traditional instruction.

In a time of changing health care and funding restraints in institutions, continuing education and staff development departments are being challenged to produce better prepared nurses at reduced costs per employee. Improvements in how nurses are prepared are needed to ensure higher levels of competence without increasing the cost. This article describes the development and use of a practical strategy for mastery learning known as Student-Oriented Learning Outlines or SOLOs. This approach has been found to be effective in producing improvements in learning and ultimately patient care while reducing cost to the institution.

Teaching basic dysrhythmias: what is the best approach?

Nurses' ability to accurately interpret cardiac dysrhythmias has resulted in decreased mortality. Four educational approaches to teaching dysrhythmia interpretation were evaluated. Major findings revealed learning was more effective when the lecture-discussion approach was used over a 5-week to 10-week period of time. Nurses also felt more comfortable with their ability to interpret dysrhythmias. These findings have several implications for continuing education departments regarding how and over what period of time this content should be taught.

Lymphotoxin-beta receptor signaling complex: role of tumor necrosis factor receptor-associated factor 3 recruitment in cell death and activation of nuclear factor kappaB.

The binding of heterotrimeric lymphotoxin, LT alpha1 beta2, to the LTbeta receptor (LTbeta R), a member of the tumor necrosis factor receptor (TNFR) superfamily, induces nuclear factor kappaB (NF-kappaB) activation and cell death in HT29 adenocarcinoma cells. We now show that treatment with LT alpha1 beta2 or agonistic LTbeta R antibodies causes rapid recruitment of TNFR-associated factor 3 (TRAF3) to the LTbeta R cytoplasmic domain. Further, stable overexpression of a TRAF3 mutant that lacks the RING and zinc finger domains inhibits LTbeta R-mediated cell death. The inhibition is specific for LTbeta R cell death signaling, since NF-kappaB activation by LT alpha1 beta2 and Fas-mediated apoptosis are not inhibited in the same cells. The mutant and endogenous TRAF3s are both recruited at equimolar amounts to the LTbeta R, suggesting that the mutant disrupts the function of the signaling complex. These results implicate TRAF3 as a critical component of the LTbeta R death signaling complex and indicate that at least two independent signaling pathways are initiated by LTbeta R ligation.

Apoptosis mediated by the TNF-related cytokine and receptor families.

T lymphocytes use several specialized mechanisms to induce apoptotic cell death. The tumor necrosis factor (TNF)-related family of membrane-anchored and secreted ligands represent a major mechanism regulating cell death and cell survival. These ligands also coordinate differentiation of tissue to defend against intracellular pathogens and regulate development of lymphoid tissue. Cellular responses are initiated by a corresponding family of specific receptors that includes two distinct TNFR (TNFR60 and TNFR80), Fas (CD95), CD40, p75NTF, and the recently identified lymphotoxin beta-receptor (LT beta R), among others. The MHC-encoded cytokines, TNF and LT alpha, form homomeric trimers, whereas LT beta assembles into heterotrimers with LT alpha, creating multimeric ligands with distinct receptor specificities. The signal transduction cascade is initiated by transmembrane aggregation (clustering) of receptor cytoplasmic domains induced by binding to their multivalent ligands. The TRAF family of Zn RING/finger proteins bind to TNFR80; CD40 and LT beta R are involved in induction NF kappa B and cell survival. TNFR60 and Fas interact with several distinct cytosolic proteins sharing the "death domain" homology region. TNF binding to TNFR60 activates a serine protein kinase activity and phosphoproteins are recruited to the receptor forming a multicomponent signaling complex. Thus, TNFRs use diverse sets of signaling molecules to initiate and regulate cell death and survival pathways.

Preparing nurses for the inevitable: the New Madrid earthquake.

Although this article discusses earthquake preparedness for the New Madrid seismic zone, registered nurses in any location will be on the front line as patient caregivers and managers in the event of a damaging earthquake. Two self-instructional modules were developed to educate registered nurses about earthquake preparedness. Statistical analyses of pretest and posttest scores from nurses who completed the modules and from nurses who participated in a control group reveal that the modules are effective educational tools. This information will make them more effective as nurses during and after an earthquake and emphasizes the need for their involvement in disaster mitigation and planning.

Strategies for practice as a clinical nurse specialist in a small setting.

The size of setting impacts the clinical nurse specialist's (CNS) practice in a myriad of ways. The many differences between small and large settings that affect the CNS role are identified, and the roles of clinician, educator, executive, and researcher illuminate facts and provide examples that demonstrate the limitations and benefits of a small setting. The three specialty areas represented include oncology, cardiovascular, and gerontology/community health. Practical strategies for practice of the clinical nurse specialist in a small or nontraditional setting are provided.