Building research infrastructure and multisite studies in merged health care settings: A framework for nurse scientists and health care leaders.

BACKGROUND: Merged healthcare settings, particularly those with Magnet designated sites, present distinct opportunities for PhD nurse scientists developing nursing research infrastructure. PURPOSE: This article aims to assist nurse scientists and healthcare leaders in defining nurse scientist roles, and in developing research infrastructure for conducting multi-site research in merged settings. METHOD: Practical strategies and a framework are provided to assist in building and navigating nurse scientist roles and research infrastructure development. DISCUSSION: Emphasizing the necessity of organizational support, the article underscores the importance of clear role delineation and leadership support. CONCLUSION: To optimize the contributions of nurse scientists in merged healthcare settings, especially in Magnet organizations, clear role definitions, robust research infrastructure, and strong organizational support are imperative.

Melanoma in the elderly patient.

BACKGROUND: The incidence of cutaneous melanoma is rising steadily, and the rate of increase is among the highest for any form of cancer. Although the reliability of age as a prognostic factor is debatable, several studies suggest that age has an important prognostic use. HYPOTHESIS: Age alone does not predict a poor prognosis in the older patient with melanoma. SETTING: University teaching hospital. METHODS: A retrospective review was undertaken to identify patients aged 65 years or older with intermediate-thickness melanoma (1-4 mm). Two hundred thirteen such patients were identified. Data are given as mean +/- SD. RESULTS: The mean age was 72.2+/-6.1 years. The mean follow-up was 49 months. By univariate analysis, the mean disease-free survival (DFS) and overall survival (OS) for lymph node-positive patients was 36.0+/-9.6 and 56.0+/-10.6 months, respectively. The mean DFS for node-negative patients was 155.0+/-9.8 months, and the mean OS was 166.0+/-9.2 months (P<.001 for both). The mean DFS and OS for women were 151.0+/-11.2 and 163.0+/-10.9 months, respectively. In contrast, men had 116.0+/-9.5 months' DFS and 127.0+/-9.0 months' OS (P=.01 for both). By multivariate analysis, lymph node status was the most predictive variable for DFS and OS (P<.001 for both). Sex tended to affect OS (P=.02) but did not achieve prognostic significance on DFS (P=.09). Other factors such as location, ulceration, histological type, and mitoses per square millimeter failed to show any prognostic significance. Stratification into 3 age groups (65-70, 71-80, and >80 years) had no significant effect on DFS (P=.95) or OS (P=.92). CONCLUSIONS: Lymph node status is the most important prognostic factor in older patients with intermediate-thickness melanoma. Identification of high-risk factors may help stratify these patients for recommendation of more aggressive treatment or adjuvant therapies. Among these patients, age alone was not a significant prognostic factor in the clinical management of melanoma.

Mechanisms of sex differences in rat cardiac myocyte response to beta-adrenergic stimulation.

The purpose of this study was to investigate sex differences in the functional response of isolated rat heart ventricular myocytes to beta-adrenergic stimulation and in isoproterenol-stimulated signal transduction. Fractional shortening was measured using a video edge-detection system in control- and isoproterenol-stimulated myocytes that had been isolated from weight-matched rats. Number and affinity of the beta-adrenergic receptors and the L-type Ca(2+) channel were measured in ventricular cardiac membranes by radioligand binding studies. Control- and isoproterenol-mediated alteration in Ca(2+) current density (I(Ca)) was determined by patch clamping and cellular cAMP content was determined by radioimmunoassay. Study results demonstrate that female myocytes have higher Ca(2+) channel density and greater I(Ca) than male myocytes. However, isoproterenol elicits a greater beta-adrenergic receptor-mediated increase cell shortening, I(Ca) and cAMP production in male myocytes. Male myocytes were also found to have a higher beta-adrenergic receptor density. These results suggest that cardiac myocytes from male rats have an enhanced response to beta-adrenergic stimulation due to augmented beta-adrenergic signaling that results in a greater transsarcolemmal Ca(2+) influx.