Law, Regulation or Just Damned Politics: The Under-utilisation and Undervaluing of the World's Largest Health Workforce.

This article analyses the outcomes of a three-year campaign to raise the status and profile of nursing - The Nursing Now Campaign. The Campaign aim was to take forward the recommendations of the Triple Impact Report of the United Kingdom All-Party Parliamentary Group (APPG) on Global Health. The Triple Impact Report documented the undervaluing and under-utilisation of nursing which is the largest health workforce globally and which the APPG believed had the greatest potential to have a positive impact upon the United Nations move to universal health coverage. The framework for analysis is that of Shiffman et al which was developed to explain the emergence and effectiveness of global networks, and is used here to examine the effectiveness of the Nursing Now Campaign against its stated aims.

Our future is global: nursing leadership and global health.

Global health matters to every nurse everywhere. In this article we outline why. We highlight some important health issues confronting the world today; explore how these issues are being tackled; and consider the implications for nursing. We describe how nurses are making a difference in the challenging contexts, range and complexity of nursing work round the globe, and we conclude with a call to action. Nurses can influence, and become, policy-makers and politicians, and explain to them why the Sustainable Development Goals cannot be reached without strengthening nursing. In this International Year of the Nurse and Midwife, the window of opportunity is open, but it will not stay open for long. Nurses and midwives globally and locally must be ready to jump through it. We ask you to join hands, and join us.

Our future is global: nursing leadership and global health / Nosso futuro é global: liderança em enfermagem e saúde global / Nuestro futuro es global: el liderazgo en Enfermería y la salud global

Global health matters to every nurse everywhere. In this article we outline why. We highlight some important health issues confronting the world today; explore how these issues are being tackled; and consider the implications for nursing. We describe how nurses are making a difference in the challenging contexts, range and complexity of nursing work round the globe, and we conclude with a call to action. Nurses can influence, and become, policy-makers and politicians, and explain to them why the Sustainable Development Goals cannot be reached without strengthening nursing. In this International Year of the Nurse and Midwife, the window of opportunity is open, but it will not stay open for long. Nurses and midwives globally and locally must be ready to jump through it. We ask you to join hands, and join us.

A saúde global importa para os enfermeiros do mundo todo. Neste artigo, descrevemos o motivo. Destacamos algumas questões de saúde importantes que o mundo está enfrentando atualmente; exploramos como essas questões estão sendo abordadas; e consideramos as implicações para a Enfermagem. Descrevemos como os enfermeiros estão fazendo a diferença nos contextos desafiadores, destacamos a extensão e a complexidade dos trabalhos dos enfermeiros ao redor do mundo, e concluímos com um apelo à ação. Os enfermeiros podem influenciar, e se tornarem, elaboradores de política e políticos, e explicar para eles o motivo pelo qual os Objetivos de Desenvolvimento Sustentável não podem ser alcançados sem fortalecer a Enfermagem. Neste Ano Internacional da Enfermagem e da Obstetrícia, a janela de oportunidade está aberta, mas não ficará aberta por muito tempo. Os enfermeiros e as parteiras devem estar prontos para atravessar essa janela, tanto em nível global quanto local. Pedimos que vocês deem as mãos e juntem-se a nós.

La salud global es importante para cualquier enfermera en cualquier lugar del mundo. En este artículo detallamos por qué. Destacamos algunos problemas de salud importantes que enfrenta el mundo actualmente, estudiamos de qué manera se están abordando estos problemas y consideramos las repercusiones para la Enfermería. Describimos de qué manera las enfermeras están marcando la diferencia en los contextos problemáticos, la amplitud y complejidad del trabajo de Enfermería en todo el planeta y concluimos con una convocatoria para la acción. Las enfermeras pueden influenciar a los encargados de elaborar normas y a los políticos (además de pasar a desempeñar esos roles) y explicarles por qué las Metas de desarrollo sustentable no pueden alcanzarse sin fortalecer la Enfermería. En este Año Internacional de las Enfermeras y Parteras la ventana de las oportunidades está abierta, pero no será así por mucho tiempo. Tanto a nivel global como local, las enfermeras deben estar preparadas para aprovecharla. Les pedimos que se tomen de las manos y que se sumen a nosotros.

Nursing leadership and health policy: everybody's business.

We all know great leadership when we see it. Outstanding nurse leaders, guided by a moral compass, simultaneously see the big picture and the consequences at micro level. While policy and politics determine health and nursing practice, most nurses just want to get on with their day job. They carry out decisions made by others but have little say in them, and weak influence or status, although they are increasingly knowledgeable and skilled. In settings where policy decisions are made - parliaments, governments, and boardrooms - nurse leaders are often neither heard nor heeded. This is starting to change. The global Nursing Now campaign is working with the International Council of Nurses, and the World Health Organization, to create and strengthen strategic nursing leadership, as modelled by the International Council of Nurses' Global Nursing Leadership Institute. A new window of opportunity is opening, with the bicentennial of Florence Nightingale's birth in 2020. Now is the moment!

Department of Veterans Affairs Consensus: Preradiation dental treatment guidelines for patients with head and neck cancer.

Few protocols have been published for the dental management of patients with head and neck cancer to prevent complications from head and neck radiation therapy. Radiation therapy not only affects the tumor cells targeted, but also the dentition, bone, salivary gland, and oral soft tissue structures. A comprehensive dental evaluation prior to head and neck radiation therapy can help prevent many complications. The following clinical guidelines were established by a workgroup of oral health providers within the Department of Veterans Affairs. This workgroup focused on developing a set of recommendations regarding dental care prior to the initiation of head and neck radiation therapy based on the best clinical evidence and expert consensus. A systematic algorithm was developed for the evaluation including pre-exam data gathering, examination, education, and treatment, followed by maintenance and postradiation dental follow-up. This document is evidence-based, patient-centered, consistent with accepted practices of care and safety, and in accordance with applicable statutes and regulations.

Yeast lifespan variation correlates with cell growth and SIR2 expression.

Isogenic wild type yeast cells raised in controlled environments display a significant range of lifespan variation. Recent microfluidic studies suggest that differential growth or gene expression patterns may explain some of the heterogeneity of aging assays. Herein, we sought to complement this work by similarly examining a large set of replicative lifespan data from traditional plate assays. In so doing, we reproduced the finding that short-lived cells tend to arrest at senescence with a budded morphology. Further, we found that wild type cells born unusually small did not have an extended lifespan. However, large birth size and/or high inter-generational growth rates significantly correlated with a reduced lifespan. Finally, we found that SIR2 expression levels correlated with lifespan and intergenerational growth. SIR2 expression was significantly reduced in large cells and increased in small wild type cells. A moderate increase in SIR2 expression correlated with reduced growth, decreased proliferation and increased lifespan in plate aging assays. We conclude that cellular growth rates and SIR2 expression levels may contribute to lifespan variation in individual cells.

The Magic Pudding Comment on "Four Challenges That Global Health Networks Face".

This commentary reflects on the contribution of this editorial and its "Three Challenges That Global Health Networks Face" to the totality of the framework developed over the past decade by Shiffman and his collaborators. It reviews the earlier works to demonstrate that the whole is greater than the sum of the parts in providing a package of tools for analysis of network effectiveness.Additionally the assertion is made that the framework can be utilised in reverse to form a map for action planning for network activity around a potential health policy issue.

Structural positioning of nurse leaders and empowerment.

AIMS AND OBJECTIVES: To analyse the reporting structures of nursing leaders of publicly funded hospitals and seek both the views of nurse leaders and Chief Executive Officers/Chief Operating Officers on the structural positioning of nurse leaders in the organisation. BACKGROUND: Concern that the continuing restructuring within hospital structures and focus on economic outputs in health services is diminishing the value of nursing leadership. DESIGN: Qualitative surveys with Nursing leaders and Chief Executive Officers of public hospitals. METHODS: Seventeen Directors of Nursing and 10 Chief Executive Officer/Chief Operating Officers' responses were received using two semi-structured questionnaires. Themes were developed from data coded and analysed by hand. RESULTS: Four broad themes emerged from analysis of the data: (1) variable positional reporting between Director of Nursing and Chief Executive Officers occurred; (2) variable levels of inclusion and influence at the executive decision-making level; (3) ambiguous financial responsibilities and accountabilities held by Director of Nursing; and (4) blurred lines existed between operational and professional reporting lines. Findings unique to the research indicate that the varying levels of visibility and inclusion impact on the structural positioning of nurse leaders which influences authority and empowerment. CONCLUSION: Responses from the data analysis indicate that the structural power of nurse leaders defined by the factors of opportunity, power and proportion were hindered by dual accountability reporting lines and a lack of financial control. RELEVANCE TO CLINICAL PRACTICE: The structural positioning of nurse leaders is vital to ensure that they are empowered and able to meet the adaptations required in a changing environment that supports the delivery of effective, quality healthcare.

The effects of sustained delivery of estrogen on bone strength and cardiovascular panels in osteoporotic female rats.

Osteoporosis and cardiovascular disease (CVD) are common age-related conditions, which are major public health problems leading to an increase in mortality, morbidity, and disability. There have been several connections found between CVD and osteoporosis such as common genetic factors, risk factors, and pathological mechanisms. There is a direct effect of estrogen on CVD and osteoporosis that is demonstrated by the manifestation of estrogen receptors on osteoblasts, osteoclasts, and vascular endothelial and smooth muscle cells. Loss of estrogen has been found to be involved in the pathogenesis of atherosclerosis and bone loss through modulation of other factors including cytokines and oxidized lipids. The goal of this proposed research was to determine if sustained delivery of estrogen is capable of regulating bone cell function while improving cardiovascular panels. Ovariectomized Sprague Dawley rats were administered estradiol at a rate of 5ng/day over an eight-week period. Body weights, estradiol levels, cholesterol levels, and bone strength were determined at 2, 4, and 8 weeks following sustained delivery of estradiol and compared with intact control and ovariectomized control animals. Estrogen replacement resulted in improved cholesterol panels without significant changes in bone flexural strength or improvements in bone porosity. Additional long term studies are needed to determine if the benefits of estrogen replacement outweigh the inherent risks associated with hormone replacement therapies.

Pain assessment and management strategies for elderly patients.

Home healthcare nurses play a critical role in pain assessment and management in elderly patients. People 65 years of age and older are the largest consumers of prescription and nonprescription pain medications in the United States and are at increased risk for adverse reactions and inadequate pain management. This article seeks to explore strategies to assist hospice and home healthcare nurses in assessing and managing elderly patients' pain. The goal is to provide tools to assist nurses in streamlining elderly patient care and improving quality of life while decreasing mortality and morbidity for this patient population.

The effects of sustained delivery of estrogen and demineralized bone matrix proteins on bone in ovariectomized female rats - biomed 2013.

Osteoporosis affects over ten million persons within the United States and is estimated to cost the healthcare system $18 billion dollars a year. Approximately 1.5 million persons will be diagnosed with an osteoporotic fracture and the epidemiological data reflects that prevalence of the osteoporotic fractures is four times more common than having a stroke. The current treatments strategies for osteoporosis are geared toward inhibiting the osteoclast cell resorption of bone, and not on the osteoblast bone formation. The use of demineralized bone matrix proteins (DBM) has been shown to be effective in healing osteoporotic bone fractures within a four week time period. Our goal was to deliver in a sustained manner DBM over an eight week period and compare bone strength and bone histology to osteoporotic untreated animals, osteoporotic animals given sustained delivery of physiological estrogen, as well as naïve control (animals with ovary intact). Our results showed estrogen administered in a sustained fashion was able to reverse the decline in bone strength and re-establish the bone quality similar to ovary intact controls. DBM administered in a sustained manner showed similar bone quality and strength to osteoporotic control animals. Administration of DBM to mature bone in a sustained fashion may be ineffective in inducing osteoblast function or reversing osteoclast activity. It is possible that DBM may be more effective on immature bone cells.

The effects of demineralized bone matrix proteins, estrogen, and an antagonist to neuropeptide y on osteoblast and osteoclast viability and function related to osteoporosis.

Currently, osteoporosis affects over half of our population beyond the age of 50, and hip fractures related to osteoporosis accounted for direct costs of $18 billion in 2002 ("About Osteoporosis: Fast Facts", 2006). The average length of a hospital stay for a primary fracture diagnosis is nearly one week, and approximately 25% of previously independent older patients who sustain hip fractures remain in long-term care for over a year. In response to the necessity for improved fracture care and shortened healing time, the field of orthopaedic surgery has begun to turn toward cellular and molecular biology research for the next answer. The goal of the proposed research is to determine if current treatment and potentially new therapeutic compounds are capable of regulating bone cell function. Osteoblast and osteoclast cells were treated for periods of 24, 48 and 72 hours in the presence of estrogen, demineralized bone matrix proteins, or an antagonist to neuropeptide Y. Following the incubation, cell viability, cell function, and morphology were determined. The results indicated a significant increase in osteoblast proliferation and alkaline phosphate production in cells treated with estrogen and DBM without evidence of cellular damage. DBM and estrogen did not affect osteoclast cell numbers, while neuropeptide Y antagonist reduced osteoclast numbers. The data shows Y antagonist may be a useful and safe compound that could be used in the treatment of osteoporotic fractures.

Antibodies against insulin measured by electrochemiluminescence predicts insulitis severity and disease onset in non-obese diabetic mice and can distinguish human type 1 diabetes status.

BACKGROUND: The detection of insulin autoantibodies (IAA) aids in the prediction of autoimmune diabetes development. However, the long-standing, gold standard 125I-insulin radiobinding assay (RBA) has low reproducibility between laboratories, long sample processing times and requires the use of newly synthesized radiolabeled insulin for each set of assays. Therefore, a rapid, non-radioactive, and reproducible assay is highly desirable. METHODS: We have developed electrochemiluminescence (ECL)-based assays that fulfill these criteria in the measurement of IAA and anti-insulin antibodies (IA) in non-obese diabetic (NOD) mice and in type 1 diabetic individuals, respectively. Using the murine IAA ECL assay, we examined the correlation between IAA, histopathological insulitis, and blood glucose in a cohort of female NOD mice from 4 up to 36 weeks of age. We developed a human IA ECL assay that we compared to conventional RBA and validated using samples from 34 diabetic and 59 non-diabetic individuals in three independent laboratories. RESULTS: Our ECL assays were rapid and sensitive with a broad dynamic range and low background. In the NOD mouse model, IAA levels measured by ECL were positively correlated with insulitis severity, and the values measured at 8-10 weeks of age were predictive of diabetes onset. Using human serum and plasma samples, our IA ECL assay yielded reproducible and accurate results with an average sensitivity of 84% at 95% specificity with no statistically significant difference between laboratories. CONCLUSIONS: These novel, non-radioactive ECL-based assays should facilitate reliable and fast detection of antibodies to insulin and its precursors sera and plasma in a standardized manner between laboratories in both research and clinical settings. Our next step is to evaluate the human IA assay in the detection of IAA in prediabetic subjects or those at risk of type 1 diabetes and to develop similar assays for other autoantibodies that together are predictive for the diagnosis of this common disorder, in order to improve prediction and facilitate future therapeutic trials.

Building capacity in Australian interprofessional health education: perspectives from key health and higher education stakeholders.

OBJECTIVE: A substantial literature engaging with the directions and experiences of stakeholders involved in interprofessional health education exists at the international level, yet almost nothing has been published that documents and analyses the Australian experience. Accordingly, this study aimed to scope the experiences of key stakeholders in health and higher education in relation to the development of interprofessional practice capabilities in health graduates in Australia. METHODS: Twenty-seven semi-structured interviews and two focus groups of key stakeholders involved in the development and delivery of interprofessional health education in Australian higher education were undertaken. Interview data were coded to identify categories that were organised into key themes, according to principles of thematic analysis. RESULTS: Three themes were identified: the need for common ground between health and higher education, constraints and enablers in current practice, and the need for research to establish an evidence base. Five directions for national development were also identified. CONCLUSIONS: The study identified a range of interconnected changes that will be required to successfully mainstream interprofessional education within Australia, in particular, the importance of addressing issues of culture change and the need for a nationally coordinated and research informed approach. These findings reiterate those found in the international literature.