Biostatistical prediction of genes essential for growth of Anaplasma phagocytophilum in a human promyelocytic cell line using a random transposon mutant library.

Anaplasma phagocytophilum (Ap), agent of human anaplasmosis, is an intracellular bacterium that causes the second most common tick-borne illness in North America. To address the lack of a genetic system for these pathogens, we used random Himar1 transposon mutagenesis to generate a library of Ap mutants capable of replicating in human promyelocytes (HL-60 cells). Illumina sequencing identified 1195 non-randomly distributed insertions. As the density of mutants was non-saturating, genes without insertions were either essential for Ap, or spared randomly. To resolve this question, we applied a biostatistical method for prediction of essential genes. Since the chances that a transposon was inserted into genomic TA dinucleotide sites should be the same for all loci, we used a Markov chain Monte Carlo model to estimate the probability that a non-mutated gene was essential for Ap. Predicted essential genes included those coding for structural ribosomal proteins, enzymes involved in metabolism, components of the type IV secretion system, antioxidant defense molecules and hypothetical proteins. We have used an in silico post-genomic approach to predict genes with high probability of being essential for replication of Ap in HL-60 cells. These results will help target genes to investigate their role in the pathogenesis of human anaplasmosis.

Factors limiting evaluation of health care programs for the homeless.

The problem of homelessness and the need for health care by homeless people does not seem to be subsiding. All indications are that current legislation to implement dramatic welfare reform will eventually increase the number of homeless persons. Evaluation to guide, monitor, and select the most effective approaches in the provision of health care will remain a key element in health care delivery. Although barriers regarding evaluation of homeless health care have been reported by previous researchers as similar, the results in this study document findings elicited from administrators in the field. The administrators have the expertise to address some of the more common barriers and reduce them. Ways to approach this endeavor and to support staff in participating in and successfully integrating evaluation activities into health care provision will require attention of funding agencies, program administrators, and inclusion of staff and clients in planning. As the era of managed care becomes the focus of how health care is delivered, evaluation of existing programs will be essential to their survival. The descriptive information obtained in this exploratory study provides useful instruction for considering issues that need to be addressed in planning and implementing evaluation of health care to homeless persons.

Focus groups describe rural nursing in New York state.

Focus groups were conducted at three sites in rural regions of New York state to describe the nature of rural nursing in terms of scope of practice, barriers, needs, and resources. Five nurses from a variety of rural practice settings participated in each group (n = 15), which was led by a nurse facilitator who was a member of the New York State Nurses Association Committee on Rural Nursing. The focus group methodology included a semi-structured format in which three defined questions were circulated before the meeting and addressed in sequence at the meeting according to the established and prearranged agenda. Key characteristics defining the scope of rural nursing included autonomy, flexibility, and creativity. The main needs identified were for accessible education and professional collegial relationships. Resources included the ease of communication without complex structures, interdisciplinary interaction and respect, and the sense of being part of the community in which the practice agency existed. Despite the barriers, these rural nurses received a great deal of satisfaction from their nursing activities and felt that they made a significant contribution to health care in their community. They also had feasible suggestions to address their needs.

Readiness of nurses for electronic networking for quality assessment and improvement.

Quality assessment and improvement (QAI) is a rapidly evolving component of health care. Its operationalization in clinical practice can be greatly enhanced by information sharing, best practice networking, and communication of experiences and resources. Nurses play a key role in both QAI and information sharing in this endeavor. Electronic communication supports the rapid sharing of QAI-related information across agencies to link nurses with a common interest in continuously improving the quality of health care delivery. It offers the opportunity to diminish the barrier of distance, which is especially relevant for nurses in rural areas. Before electronic communication was established as an information-sharing mechanism, however, the readiness of nurses in both rural and urban/suburban settings was assessed. A convenience sample of nurses in western New York, who were surveyed via written questionnaire regarding electronic communication, most often described their comfort in using this medium as uncertain. This finding supports the need for preliminary preparation focusing upon the skills and experience needed to utilize the computer as a communication medium.

In a changing world: database to keep the pace.

A database to manage health care information can be an especially useful tool for the CNS. Systematic management of information is important in the multifaceted role characteristic of the CNS's scope of practice. The CNS not only provides theoretically sound creative care to patients and serves as a role model to nursing staff, but also monitors and substantiates the quality and effectiveness of care delivered. To do this, the CNS participates in research activities and synthesizes and uses research findings. These aspects of professional practice require collection and analysis of information that could be facilitated by the use of a database. The purposes of this article are to introduce some basic concepts of database and its relevance and contribution to the CNS, discuss issues inherent in setting up a database, and provide guidelines for CNSs who are considering using a database in their clinical practice.

Combining work and home.

The health consequences for women of combining work outside the home with domestic responsibilities are reviewed. The chapter evaluates role stress as a function of multiple roles and concludes that such juggling promotes women's health by offering increased variety of functions performed as well as increased emotional buffering. The chapter also concludes that women's working outside the home has a positive effect likewise on children and spouses.

Staff development challenge: assuring nurses' competency in quality assessment and improvement.

Nursing administrators and nursing staff development educators face a challenge to insure that nursing staff are prepared to participate in quality assurance, assessment and improvement. This challenge is influenced by the evolving nature of quality assessment and improvement and the need to stay current in the field. This article suggests that staff development for quality assessment and assurance is a feasible approach to remedy the gap between the educational preparation and clinical practice expectations of nurses. Considerations to provide nurses with staff development offerings about quality assessment and improvement are discussed. Program topics are suggested.

Well-being and concerns of patients with peripheral arterial occlusive disease.

Peripheral arterial obstructive disease (AOD) affects an estimated 2.4 million persons in the United States, resulting in disability, morbidity, and even death in the elderly. Insight into the general well-being (GWB) of patients who have AOD can enhance the comprehensiveness of nursing care provided to these patients. GWB was examined in a study of 170 patients with peripheral AOD treated at a Veterans Affairs Medical Center (VAMC). The GWB instrument constructed by Dupuy and used extensively by the Rand Corporation was administered to provide an objective measure of well-being. Two open-ended questions regarding patients' concerns associated with their AOD provided more subjective information. The mean GWB score for the VAMC patients was lower than the mean score reported by the Rand Corporation for a group of healthy individuals, and this lent support to the construct validity of the instrument. The general health and vitality subscales appeared to have the widest difference in mean scores. Within the VAMC patient sample, GWB did not vary among age groups but did vary slightly in an inverse direction with the severity of the circulatory impairment. The concerns noted included fear of increased pain, lack of mobility, and fear of amputation.

Long-term care nurses identify educational needs regarding quality assessment and improvement.

An increasing demand is being placed on nurses who are practicing in long-term care settings to conduct and/or participate in quality assessment and improvement (QAI) activities. A local survey of directors of nursing in long-term care indicated both personal interest and interest on the part of their staff nurses to attend continuing education (CE) programs regarding quality of care to increase their competencies in this area. Specific interest areas and recommendations for an educational offering regarding quality assessment and improvement for long-term care nurses are described.

PVD: nurse--patient interventions.

The intervention program described began with teaching patients in simple terms about PVD, associated risk factors, and why change is important. Teaching aids such as posters and booklets were used to supplement discussion. Positive reinforcement was emphasized. Phone calls, follow-up visits, encouragement and praise were frequent. Newsletters focusing on different aspects of the various risk factors were developed and mailed monthly. Patients were encouraged and helped to develop an individualized program of change based on discussions and practicality. They were encouraged to start slowly and increase gradually. Emphasis was placed on reinforcement, self-help, and praise for efforts. Patients were encouraged to keep a brief daily log of progress and thoughts. Regularly scheduled physical assessments provided a tool to assess change and provide tangible evidence of their ability to set a goal, follow through, and make life-style change.

Chemical impairment in colleagues: perceptions of Western New York nurses.

The purpose of this study was to determine nurses' perceptions about substance abuse in professional colleagues, opinions about strategies for dealing with substance abuse, and knowledge about resources available for dealing with the problem of chemical impairment. Subjects included a convenience sample of 161 nurses from Western New York. Data were gathered by a questionnaire that included "The Perceptions of Nursing Impairment Inventory" and items regarding respondents' background characteristics, suspicions about alcohol and drug abuse in nurse colleagues, and knowledge about and use of peer assistance services available through District I of the New York State Nurses Association. The major outcome of the study was identification of a knowledge deficit on the extent of the substance abuse problem in nursing, ability to recognize an impaired colleague, and awareness of services available. These data substantiate the need for implementing educational programs to increase nurses' basic knowledge of, and sensitivity to, the problem of chemical dependency.

A national survey to identify evaluation criteria for programs of health care for homeless.

We know that programs to deliver health care to the homeless are springing up all over the nation, but are they effective? Hunter, Crosby, Ventura and Warkentin attempt to get a sense of what data is being collected. In doing so, they identify the difficulties in collecting data on this transient population.

An information synthesis to evaluate nurse practitioner effectiveness.

An information synthesis was conducted at the Department of Veterans Affairs Medical Center, Buffalo, New York, to determine the extent to which nurse practitioner (NP) effectiveness had been established in the existing literature. Three hundred fifty documents were reviewed by experts and 102 documents were deleted from the analysis phase. Fifty-six documents referred to as the Better Studies contained the most relevant and valid findings and were compared with a model developed to represent NP effectiveness. NPs were found to effectively provide a wide range of health care services. They can function as independent health care providers as well as collaborative members of the health care team. NPs have been found to have a positive influence on patient-related outcomes. There should be continued use and support of NPs in health care delivery systems. Recommendations for additional study are presented.

Needs of nurse educators & clinical nurses regarding quality assurance education.

A study was done to determine the needs and educational interest regarding quality assurance of nurses practicing in both academic and clinical settings in Western New York. A written survey questionnaire was developed and distributed to a convenience sample. Responses were received from 98 nurse educators (47% of those contacted) and from 148 clinical area nurses (42% of those contacted). Concepts about quality assurance were itemized and respondents indicated their level of interest in obtaining further information to increase their QA competencies about each. The topics of interest to both groups were similar and included standards of care, legal issues, documentation, techniques for implementation of QA in clinical practice, and measures of quality of care. Characteristics about a continuing education offering that would be desirable were specified.

Enhancing subject recruitment for nursing research.

Nursing research most often requires human subjects. Consequently, an essential component in planning and conducting research entails recruitment of subjects who knowledgeably consent to participate. A well-established theoretical base exists regarding sampling techniques and procedures for research methods. The operationalization of the theory into practical terms may be of interest to the clinical nurse specialist (CNS) who frequently assumes a leadership role to both conduct nursing research in practice settings and to advise other nurses interested in conducting research. The recruitment efforts in four different nursing studies were compared and contrasted in an effort to determine effective and efficient approaches to this issue. Sample populations included nurse practitioners, patients, nurse aides, and nurse educators. Methods of recruitment included direct contact, mail, and telephone contact. While the settings, purposes, and designs of the studies varied, some common elements regarding subject recruitment were suggested. The recruitment methods have been described, along with the implication in terms of practical application for conduct of nursing research by CNSs.

Increasing productivity by developing alliances.

Collaborative alliances among nurses may provide a feasible and satisfying opportunity to increase the productivity of nurses. Inherent in successful alliances are the development of trust, compatibility, commitment, and mutality of benefits. The development of collaborative relationships among clinical research nurses, a research methodologist, and a nurse educator resulted in several federally funded grants and publications. The alliances described here cross disciplines and institutions and demonstrate the enhanced productivity that can result from such efforts.

An experience in designing patient education materials.

This article describes the authors' experience in designing four booklets for patient education. Design considerations, readability estimates, layout preparation, content validity, and printing considerations are discussed.