Microbial colonization of follicular fluid: alterations in cytokine expression and adverse assisted reproduction technology outcomes.

BACKGROUND: Previous studies have measured cytokines expressed within follicular fluid and compared the profiles with the aetiology of infertility and/or successful or unsuccessful assisted reproduction technology (ART) outcomes. METHODS: In this study, 71 paired follicular fluid and vaginal secretions collected from ART patients were cultured to detect microorganisms and tested for the presence of cytokines. Patient specimens were selected for assay based on two criteria: whether the follicular fluid specimen was colonized (with microorganisms prior to oocyte retrieval) or contaminated by vaginal flora and; the aetiology of infertility. Patients included fertile women (with infertile male partners; n = 18), women with endometriosis (n = 16) or polycystic ovary syndrome (PCOS, n = 14), or couples with a history of genital tract infection (n = 9) or idiopathic infertility (n = 14). RESULTS: Microorganisms and cytokines were detected within all tested specimens. Colonizing microorganisms in follicular fluid were associated with: decreased fertilization rates for fertile women (P = 0.005), women with endometriosis (P = 0.0002) or PCOS (P = 0.002) compared with women whose follicular fluid was contaminated at the time of oocyte retrieval and with decreased pregnancy rates for couples with idiopathic infertility (P = 0.001). A single cytokine was discriminatory for women with an idiopathic aetiology of infertility (follicular fluid interleukin (IL)-18). Unique cytokine profiles were also associated with successful fertilization (IL-1α, IL-1ß, IL-18 and vascular endothelial growth factor). CONCLUSIONS: Follicular fluid is not sterile. Microorganisms colonizing follicular fluid and the ensuing cytokine response could be a further as yet unrecognized cause and/or predictor of adverse ART outcomes and infertility.

Using the Clinical Prevention and Population Health Curriculum Framework to encourage curricular change.

The Healthy People Curriculum Task Force was established in 2002 to encourage implementation of Healthy People 2010 Objective 1.7: "To increase the proportion of schools of medicine, schools of nursing and health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." In 2004, the Task Force published a Clinical Prevention and Population Health Curriculum Framework ("Framework") to help each profession assess and develop more robust approaches to this content in their training. During the 6 years since the publication of the Framework, the Task Force members introduced and disseminated it to constituents, facilitated its implementation at member schools, integrated it into initiatives that would influence training across schools, and adapted and applied the Framework to meet the data needs of the Healthy People 2010 Objective 1.7. The Framework has been incorporated into initiatives that help promote curricular change, such as accreditation standards and national board examination content, and efforts to disseminate the experiences of peers, expert recommendations, and activities to monitor and update curricular content. The publication of the revised Framework and the release of Healthy People 2020 (and the associated Education for Health Framework) provide an opportunity to review the efforts of the health professions groups to advance the kind of curricular change recommended in Healthy People 2010 and Healthy People 2020 and to appreciate the many strategies required to influence health professions curricula.

The roles of healthcare professionals in implementing clinical prevention and population health.

Across the health disciplines, clinical prevention and population health activities increasingly are recognized as integral to the practice of their professions. Most of the major clinical health professions organizations have begun incorporating clinical prevention and population health activities and services into educational curricula, the accreditation process, and training to affect clinical practice. Students in each health profession need to understand the roles played by those in other health professions. This understanding is a prerequisite for better communication and collaboration among the professions and for accomplishing the educational objectives included in Healthy People 2020 and organized using the Education for Health framework. To help accomplish these goals, this article summarizes each health profession's contributions to the field of prevention and population health, explains how the profession contributes to interprofessional education or practice, reviews specific challenges faced in the provision of these types of services, and highlights future opportunities to expand the provision of these services. Several general themes emerge from a review of the different health professions' contributions to this area. First, having well-trained prevention and population health professionals outside of the traditional public health field is important because prevention and population health activities occur in almost all healthcare settings. Second, because health professionals work in interprofessional teams in the clinical setting, training and educating all health professionals within interprofessional models would be prudent. Third, in order to expand services, reimbursement for health promotion counseling, preventive medicine, and disease management assistance needs to be appropriate for each of the professions.

Adopting narrative pedagogy to improve the student learning experience in a regional Australian university.

A growing body of work in the literature describes and explains narrative pedagogy within nursing and midwifery programs. This paper continues the conversation by explaining, with examples, how narrative pedagogy has been interpreted and applied within a new nursing faculty in Australia. The aims of our nursing and midwifery programs are to provide students with a clear professional identity and to prepare them for contemporary Australian nursing practice. As part of these aims, we want students to develop their imaginations and to consciously examine, and challenge, nursing and healthcare paradigms and practices such as the enduring illness model of healthcare and the emphasis on technique-oriented care. Members of our teaching team, working together and individually, have used narrative pedagogy in a variety of ways, developing novel teaching and learning activities for use in real time classroom settings as well as online to provide a regionally and globally relevant educational experience.

A systematic assessment of strategies to address the nursing faculty shortage, U.S.

This article provides an assessment of strategies implemented nationwide to counter the nursing faculty shortage, highlights those indicating most promise, and proposes a basis for evaluating outcomes. The deficit of educators is a key impediment to filling the growing demand for nurses generated by an aging population and a weak supply of new graduates, which has left up to 13% of hospital RN positions vacant. Educational institutions have adopted various approaches to expand faculty resources with the goal of increasing nursing student enrollment. After conducting a systematic review of the literature from 2000 onward, we analyzed and coded these initiatives using techniques of content analysis and constant comparison. We induced 4 large domains from the data: advocacy, educational partnerships, academic innovation, and external funding. For each domain we identified an exemplar that is substantial, sustainable and replicable. We then proposed a basis for evaluating the impact of these strategies to facilitate replication.

Maryland's agenda: moving the faculty shortage to the forefront.

As the United States faces an ever-increasing nursing and faculty shortage, Maryland has become a leader in finding innovative ways to address the faculty shortage crisis in an effort to increase the number of bedside nurses. Three years of diligent advocacy involving multiple stakeholders has finally garnered results. In December 2005, the Maryland Heath Care Cost Review Commission and Maryland's Higher Education Commission, with the support of the state government's executive and legislative branches, launched an unprecedented 10-year, $8.8 million annual initiative to address the faculty shortage in the state. This article discusses the process that led to Maryland becoming a national leader in addressing the nurse faculty shortage.

Stages of change, processes of change, and social support for exercise and weight gain in postpartum women.

OBJECTIVES: To test the extent to which social support and variables included in the Transtheoretical Model were explanatory for exercise initiation and weight maintenance in postpartum women. DESIGN: A cross-sectional descriptive design. SETTING: Data were collected in the participant's homes. PARTICIPANTS: Postpartum women who had normal pregnancies were interviewed and measured on body fat, physical activity, and psychosocial scales. MAIN OUTCOME MEASURE: (a) Stages of exercise change measure, (b) Seven Day Recall, (c) Friend and Family Support for Exercise Scale, (d) Processes of Change Questionnaire, and (e) body fat measures including body mass index and percent body fat. RESULTS: Forty percent reported engaging in vigorous activity less than 1 hour daily, 55% walked less than four city blocks daily, and 52% engaged in less than 2 hours of vigorous weekend activity. Multilinear regression showed that the processes of change contributed 36% to the body mass index, and 21% of the variance in waist-thigh ratio. Of the processes of change, environmental reevaluation correlated significantly with body mass index. CONCLUSION: The impact of a woman's weight on others as well as information concerning the health effects of obesity and physical activity could enhance the initiation of exercise in the postpartum woman.

Determining criteria for excellence in nurse practitioner education: use of the Delphi Technique.

Standards and guidelines are available to help nurse practitioner (NP) educators maintain quality in their programs. NP education is now at a juncture to develop criteria that extend beyond the basic standards to measurement of exemplary educational endeavors. In 2000, the National Organization of Nurse Practitioner Faculties Task Force for Programs of Excellence was formed and given the charge of developing criteria for recognizing exemplary nurse practitioner programs. This article reports on results and recommendations that evolved from a Delphi study to identify a set of criteria for excellence in NP programs. Thirteen expert panelists from across the United States participated in three rounds of iterations to evaluate the relevance, specificity, and comprehensiveness of 14 initial criteria and reached consensus on nine final criteria. Finally, the paper discusses ways that these criteria may be used to improve NP education through the development of a program to recognize excellence in NP education.

Clinical Prevention and Population Health Curriculum Framework: the nursing perspective.

The Clinical Prevention and Population Health Curriculum Framework (Curriculum Framework) was developed by the Healthy People Curriculum Task Force comprised of representatives from allopathic and osteopathic medicine, dentistry, nursing and nurse practitioners, pharmacy and physicians assistants. This multidiscipline Task Force was covened to address the Healthy People 2010 objective of increasing the health promotion/prevention content in health professional education. A focus on clinical prevention and population health activities is central to the goal of improving the health status of the nation and offers the greatest potential to reduce many leading causes of death and improve quality of life across diverse populations. The Curriculum Framework provides a set of 4 components (evidence base for practice, clinical preventive services, health systems/health policy and community aspects of practice) and 19 domains for organizing and implementing the curriculum. The title "Clinical Prevention and Population Health" includes both individual and population focused health promotion and prevention efforts. The role of nursing in developing the Curriculum Framework, and the tailoring and implementation of the Curriculum Framework for undergraduate and graduate programs in nursing is discussed.

Clinical prevention and population health: curriculum framework for health professions.

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

Interaction of microbiology and pathology in women undergoing investigations for infertility.

BACKGROUND: Cases of endometriosis with no tubal damage are associated with infertility, suggesting an immunological rather than mechanical barrier to reproduction. Laparoscopy and falloposcopy results of clinically asymptomatic women undergoing investigation of infertility were correlated with the outcomes of microbiological screening for Chlamydia trachomatis, Mycoplasma pneumoniae, Mycoplasma hominis, ureaplasma species, Neisseria gonorrhoeae, Neisseria meningitidis and Chlamydia pneumoniae. METHODS: A total of 44 women presenting to a hospital IVF service for laparoscopic or laparoscopic/falloposcopic investigation of infertility provided endocervical swabs, fallopian tube washings, and peripheral whole blood for analysis. RESULTS: Of these 44 women, 15.9% (7) showed evidence of C. trachomatis infection as detected by either PCR or EIA serology. Of these 7 women, 5 (71%) had no or mild endometriosis and 2 (29%) had moderate or severe endometriosis. Of the remaining 37 women who showed no evidence of chlamydial infection, 15 (40.5%) had no or mild endometriosis. CONCLUSION: Women with infertility, but without severe endometriosis at laparoscopy, showed a trend towards tubal damage and a higher rate of previous C. trachomatis infection. Although not statistically significant, this trend would suggest that, where moderate to severe tubal damage is found to be the primary cause of infertility, C. trachomatis infection could be a likely cause for such tubal damage.

Ureaplasma parvum and Ureaplasma urealyticum are detected in semen after washing before assisted reproductive technology procedures.

OBJECTIVE: To investigate the prevalence of ureaplasmas in semen and washed semen and to explore their effect on semen andrology variables. DESIGN: Prospective study. SETTING: In vitro fertilization (IVF) unit of a private hospital. PATIENT(S): Three hundred forty-three men participating in an assisted reproductive technology (ART) treatment cycle. MAIN OUTCOME MEASURE(S): The prevalence of ureaplasmas in semen and washed semen tested by culture, polymerase chain reaction assays, and indirect immunofluorescent antibody assays. RESULT(S): Ureaplasmas were detected in 73 of 343 (22%) semen samples and 29 of 343 (8.5%) washed semen samples. Ureaplasmas adherent to the surface of spermatozoa were demonstrated by indirect immunofluorescent antibody testing. Ureplasma parvum serovar 6 (36.6%) and U. urealyticum (30%) were the most prevalent isolates in washed semen. A comparison of the semen andrology variables of washed semen ureaplasma positive and negative groups demonstrated a lower proportion of nonmotile sperm in men ureaplasma positive for washed semen. CONCLUSION(S): Ureaplasmas are not always removed from semen by a standard ART washing procedure and can remain adherent to the surface of spermatozoa.

Immunopathogenesis of chlamydia trachomatis infections in women.

OBJECTIVE: To develop a model of pathogenesis by which Chlamydia trachomatis progresses from acute to chronic infection, and finally serious disease (salpingitis, tubal occlusion). DESIGN: Review of current literature located through web-based Medline searches using key words: Chlamydia trachomatis, immunology, cytokines, heat shock protein, infertility. RESULT(S): Cell-mediated immune mechanisms appear to be critical in determining whether acute infection is resolved or progresses into chronicity with pathological outcome. What determines the particular immune pathway depends on a range of determinants-HLA subtype and human genetics, cytokine profile, infectious load, route of infection, and endocrinology. A clearer picture of the natural history of chlamydial pathology may assist in providing better predictors of those women who may go on to develop significant sequelae after infection. CONCLUSION(S): Predicting those who may develop serious disease, including infertility, may contribute to improved management of such persons during earlier stages of infection and assist in prevention.