Scanning electron microscopy of the surface epithelium of the bovine endometrium.

The surface epithelium of the bovine endometrium comprises at least 2 cell types (ciliated cells and secretory cells with microvilli), but their distribution and morphological changes over the estrous cycle are poorly understood. The objective was to quantify the number of ciliated cells and assess morphological changes in secretory cells on the uterine surface epithelium during the estrous cycle. Caruncular endometrium (CAR) and intercaruncular endometrium (ICAR) samples were collected from the uterine body, the horn ipsilateral to the corpus luteum or dominant follicle (H-CL/DF), and the horn contralateral to the corpus luteum or dominant follicle (H-NCL/NDF) from heifers following slaughter on d 0 (estrus; n = 5) or d 14 (mid-luteal phase; n = 5) of the estrous cycle. Samples were prepared for scanning electron microscopy at 1,000× magnification. Four to 10 fields (256 × 225 µm) for each sample were examined (n = 567 images). The number of ciliated cells was counted and the surface was scored for the morphology of the secretory cells (0 = absence of microvilli on surface; 3 = 100% of surface covered with microvilli). Ciliated cells were present in both the CAR and ICAR regions. The number of ciliated cells per field increased from d 0 to 14 in CAR and decreased from d 0 to14 in ICAR. The scanning electron microscopy revealed a general lack of uniformity in the lawn of microvilli on the surface of the endometrium. Based on the scores, approximately 25% of the fields had a surface that was <50% covered by microvilli. Depletion of microvilli may be explained by a normal process where apical protrusions are formed and either regress back into the cell surface or break to release their contents into the uterine lumen. These studies support the hypothesis that the surface of the luminal epithelium changes during the estrous cycle through a process that involves remodeling of the apical surface. The morphology of the apical surface may have a key role in governing pregnancy establishment.

Extracorporeal membrane oxygenation in peripartum cardiomyopathy: A review of the ELSO Registry.

AIMS: Data on the use of extracorporeal membrane oxygenation (ECMO) for cardiogenic shock in peripartum cardiomyopathy (PPCM) is limited. We queried the Extracorporeal Life Support Organization (ELSO) Registry for PPCM patients treated with ECMO in order to characterize demographic and clinical features, complications, survival, and variables associated with mortality. METHODS AND RESULTS: This was a retrospective review of patients voluntarily entered into the ELSO Registry. De-identified data was collected on patients with a diagnosis of PPCM based on ICD-9/ICD-10 coding who received ECMO between 2007 and 2019. Collected data included demographics, ECMO mode, cannulation strategies, pre-ECMO ventilator, biochemical, and hemodynamic parameters, run duration, complications, and survival to wean off ECMO and hospital discharge. Our primary outcome measure was survival to discharge. In the final analysis, 88 veno-arterial (VA) ECMO patients were included. Overall, 72% of patients were weaned off ECMO, including 10% who were weaned to ventricular assist device or heart transplantation, and 64% survived to hospital discharge. Extracorporeal cardiopulmonary resuscitation (ECPR) was performed in 11% of patients with 60% survival. Factors associated with decreased survival included neurologic complications (p = 0.03), specifically central nervous system hemorrhage (p = 0.01). CONCLUSION: Our review is the largest to date of PPCM patients supported with VA ECMO for cardiogenic shock. ECMO and ECPR are valuable forms of short-term mechanical circulatory support with acceptable mortality profiles for PPCM patients who remain refractory to aggressive medical management. Complications should be meticulously avoided, especially neurologic complications.

Effect of socioeconomic deprivation and the appointment of Welfare Attorneys.

Most patients in intensive care unit (ICU) lack decision-making ability. The Adults with Incapacity (Scotland) Act 2000 allows someone to appoint a Welfare Attorney (WA) to act on their behalf should they lose capacity. Scotland has areas of major socioeconomic deprivation associated with lower life-expectancy and with a lack of knowledge about and consequently difficulty accessing services. The effect of socioeconomic deprivation on WA registration was investigated. A complete list of registered WAs was categorized by deprivation. The Public Guardian, Scotland indicated whether patients admitted to ICU at Glasgow Royal (April 2006-May 2009) had a WA registered. All Scottish ICU admissions (2004-2008) were categorized by deprivation. Twelve of 1152 ICU patients at Glasgow Royal had a WA. Of 165,997 WAs registered, 5984 were in the most deprived and 27,970 in the most affluent areas. Overall, 3.9% of the Scottish population had a WA (1.4% in the most, 6.5% in the least deprived population decile). In conclusion, the uptake of WAs was low, especially in deprived areas. The reasons could include a lack of knowledge, not anticipating the need for a WA or not being confident in the process. Any educational package needs to target the most socioeconomically disadvantaged.

INFERNO: a system for early outbreak detection and signature forecasting.

OBJECTIVE: Public health surveillance systems that monitor daily disease incidence provide valuable information about threats to public health and enable public health authorities to detect enteric outbreaks rapidly. This report describes the INtegrated Forecasts and EaRly eNteric Outbreak (INFERNO) detection system of algorithms for outbreak detection and forecasting. METHODS: INFERNO incorporates existing knowledge of infectious disease epidemiology into adaptive forecasts and uses the concept of an outbreak signature as a composite of disease epidemic curves. RESULTS: Four main components comprise the system: 1) training, 2) warning and flagging, 3) signature forecasting, and 4) evaluation. The unifying goal of the system is to gain insight into the nature of temporal variations in the incidence of infection. Daily collected records are smoothed initially by using a loess-type smoother. Upon receipt of new data, the smoothing is updated; estimates are made of the first two derivatives of the smoothed curve, which are used for near-term forecasting. Recent data and near-term forecasts are used to compute a five level, color-coded warning index to quantify the level of concern. Warning algorithms are designed to balance false detection of an epidemic (Type I errors) with failure to correctly detect an epidemic (Type II errors). If the warning index signals a sufficiently high probability of an epidemic, the fitting of a gamma-based signature curve to the actual data produces a forecast of the possible size of the outbreak. CONCLUSION: Although the system is under development, its potential has been demonstrated through successful use of emergency department records associated with a substantial waterborne outbreak of cryptosporidiosis that occurred in Milwaukee, Wisconsin, in 1993. Prospects for further development, including adjustment for seasonality and reporting delays, are also outlined.

Evaluation of a hypertension screening programme in Independence, Belize.

This study assesses the effectiveness of a hypertension-screening programme in Independence, Belize. Forty-nine of the 101 patients screened were found to have elevated blood pressure readings and were advised to seek medical care. Four months later, interviews with 35 of the 49 patients from the hypertensive group revealed that 85.7% of the patients had sought medical care. Women, elderly patients and patients with a previous history of hypertension were more likely than men, younger patients and those without a history of hypertension to seek follow-up medical care. The screening programme successfully directed a high proportion of patients with elevated blood pressure to seek appropriate medical care.

Evaluation of a hypertension screening programme in Independence, Belize / Evaluación de Programa de Pesquizaje de la Hipertensión en Independencia, Belice

This study assesses the effectiveness of a hypertension-screening programme in Independence, Belize. Forty-nine of the 101 patients screened were found to have elevated blood pressure readings and were advised to seek medical care. Four months later, interviews with 35 of the 49 patients from the hypertensive group revealed that 85.7 of the patients had sought medical care. Women, elderly patients and patients with a previous history of hypertension were more likely than men, younger patients and those without a history of hypertension to seek follow-up medical care. The screening programme successfully directed a high proportion of patients with elevated blood pressure to seek appropriate medical care

Este estudio evalúa la efectividad de un programa de pesquizaje de la hipertensión en Independencia, Belice. Se halló que 49 de 101pacientes sometidos al pesquizaje produjeron lecturas de alta presión sanguínea y tensión arterial, y se les aconsejó buscar atención médica. Cuatro meses después, entrevistas con 35 de los 49 pacientes del grupo hipertenso revelaron que el 85.7% de los pacientes habían buscado atención médica. Las mujeres, los pacientes mayores y los pacientes con una historia previa de hipertensión presentaban una probabilidad mayor a buscar atención médica de seguimiento, que los hombres, los pacientes más jóvenes y aquéllos sin una historia de hipertensión. El programa de pesquizaje tuvo éxito en hacer que una alta proporción de pacientes con presión sanguínea alta buscaran adecuada atención médica.

Developing BSN leaders for the future: the Fuld Leadership Initiative for Nursing Education (LINE).

The Helene Fuld Leadership Initiative in Nursing Education (LINE) program was designed to enhance beginning leadership competencies of baccalaureate nursing students. Given the increasing need for strong and effective leadership throughout the health care system, and the demands new graduates encounter as they move into practice, the LINE program is built on the premise that leadership skills must be instilled at the undergraduate level. The program achieves its goal through an intensive 5-day institute focused on assessing and developing the leadership competencies of nurse educators and their clinical partners to enable them to be effective agents of curriculum change in their home institutions. The institute also assists participants to redesign their baccalaureate nursing (BSN) curricula to ensure that students learn to: (1) work effectively within and across complex, integrated organizational and institutional boundaries; (2) think and act from the perspective of a system; and (3) communicate, negotiate, lead, and facilitate change within health care organizations. D. Goleman's (1998) framework of emotional intelligence, which addresses both personal competence (managing oneself) and social competence (handling one's relationships with others) provides the framework for operationalizing leadership in the BSN curriculum. To date, 26 BSN programs and their clinical partners have participated in the LINE program, which has the potential to influence the beginning leadership development of more than 2,400 BSN students. Program outcomes reveal that education-practice collaboration, professional networking, individual leadership development of nurse educators and their clinical partners as change agents, and the integration of leadership experiences at all levels of the BSN curriculum are important in developing beginning leadership competencies in BSN students.

A proposed framework for differentiating the 21 Pew competencies by level of nursing education.

Now nearly a decade old, the original Pew Health Professions Commission Competencies have stood up well to the test of time. The competencies were designed to provide all health professionals, from physicians to physical therapists, with a general guide to the values, skills, and knowledge they would need to be successful in the health care system that was beginning to emerge in the late 1980s. They have been used across the range of health professions and in many practice settings to create a framework for curricular change, work redesign, and assessment of professional competence. The interpretation of the competencies offered here should prove to be a useful tool to nurses and health system leaders as they carry on the hard work of adapting the current model of nursing practice to the demands and realties of the contemporary and continually evolving health care environment. This work is important for two reasons. First, many of the skills and attributes of the professional nurse are not adequately used or valued by the health care system because the profession is both fragmented and poorly differentiated and articulated. Without markers that define and promote collaborative practice within nursing, the full potential of nurses at all levels of preparation will continue to be inadequately and inappropriately deployed. This model exacerbates the current nursing shortage because it fails to use nurses in appropriate, well-delineated, and challenging roles. Without this kind of differentiation, one that can be owned and supported by all nurses, there will continue to be suboptimal use of the nursing workforce in the United States. The framework of differentiated Pew competencies and the companion teaching-learning strategies proposed here offer one approach to rationalizing both nursing education and practice, with the potential for improving the quality of care, and reducing fragmentation, cost, and public confusion.

Recreating nursing practice for a new century. Recommendations and implications of the Pew Health Professions Commission's final report.

The erratic path of evolution of health care in the United States creates daunting threats as well as new opportunities for institutions, professionals, and the public. Perhaps no stakeholder has more to risk or gain than professional nursing. As the largest of all the health professions, nursing serves as the backbone for much of the care delivery system. Historically, nurses have been employed primarily in hospital settings. Toward the latter part of the 20th century, however, nurses assumed such expanded roles as independent practitioners, managers of care in large health plans, and providers of alternative and complementary health care services. These new roles point to how nursing may rapidly evolve as the health care system addresses continuing issues of cost, performance, access, and consumer satisfaction. While today's opportunities are great, threats remain to the traditional role of the nurse in the hospital setting, through regulatory constraints on nursing practice and the lack of clear purpose and direction within the broad professional nursing community. Following a decade of leadership and advocacy for health professions education, the Pew Health Professions Commission issued its fourth and final report in December 1998. In this report, the Commission assessed the challenges facing professionals in the 21st century and made general and profession-specific recommendations for action.