Chief Nursing Officer Survey: BSN and Higher Degree Initiatives in North Carolina.

AIM: The purpose of this study was to determine gap areas where North Carolina should implement strategies to promote the Institute of Medicine's recommendation of an 80 percent bachelor of science workforce. BACKGROUND: The North Carolina Action Coalition sought information about the nursing BSN and higher degree workforce and about human resource policies/strategies that promote BSN and higher degree education. METHOD: An electronic survey was used to query 120 acute care hospital chief nursing officers over a four-year period and 100 public health chief nursing officers over a two-year period. RESULTS: A majority of acute care and a minority of public health institutions had policies promoting BSN education. Barriers included lack of tuition reimbursement, scheduling/staffing issues, lack of local universities, and a perceived lack of value for nurses. A minority of respondents reported an 80 percent BSN workforce. CONCLUSION: Strategies are needed statewide to support nursing academic progression.

Establishing a program of global initiatives for nursing education.

In the global nursing community, schools of nursing are increasingly developing initiatives and networks across national boundaries. This article describes the process undertaken at a school of nursing to determine its global health priorities and develop a program of global initiatives for nursing education. A series of meetings were held to determine faculty global activities and gauge interest in designing a 5-year strategic plan for the program. A volunteer Strategic Planning Work-group was convened to formalize a mission, vision, and strategic plan for the program, which were presented to, refined by, and vetted by an advisory board and the faculty at large. We recommend this process to schools committed to developing or expanding a program dedicated to global initiatives and a global perspective in educational planning. Involving stakeholders, building on current strengths, and aligning with mission and vision are essential elements for developing a meaningful program of global initiatives for nursing education.

Transitions of care in patients receiving oral anticoagulants: general principles, procedures, and impact of new oral anticoagulants.

BACKGROUND: Most patients requiring anticoagulation therapy while hospitalized will continue this therapy as outpatients. This transition can be associated with gaps in care related to anticoagulation therapy that increase the risk of adverse events, rehospitalizations, and death. Warfarin, the most commonly used oral anticoagulant, presents distinct management challenges, including drug-food and drug-drug interactions, a narrow therapeutic window, and the requirements for periodic blood monitoring and dose adjustments, particularly during the hospital discharge process. PURPOSE: This review explores clinical challenges and potential solutions surrounding anticoagulation therapy with warfarin during transitions of care, as well as discusses newer anticoagulants that are approved or are in late stages of development for the prevention of thromboembolic events. CONCLUSIONS: Diligence, careful planning, and close communication between patients and healthcare providers during and after discharge are required to ensure that patients remain adequately and safely anticoagulated with warfarin in the outpatient setting. New oral anticoagulants may offer the possibility of safer and simpler care for patients requiring anticoagulation. CLINICAL IMPLICATIONS: We summarize the latest guidelines and recommendations for safe hospital discharge and apply them to the specific case of discharging a warfarin-treated patient. In addition, we discuss the new oral anticoagulants and their potential to offer more efficacious and easier-to-manage anticoagulation.

The use of nonphysician providers in adult intensive care units.

In the United States there are not currently enough critical care-trained practitioners to provide care to all critically ill patients. With calls for "high-intensity" staffing and 24-hour coverage of our intensive care units, the board-certified intensivists we do have are being stretched ever more thin. Nonphysician providers (physician assistants and nurse practitioners) are being used with increasing frequency in critical care settings to provide care to critically ill patients. In this review, we explore the impact of introducing nonphysician providers into the adult intensive care unit.

Regionally increasing baccalaureate-prepared nurses in North Carolina: the RIBN Project.

A more highly educated nursing workforce is needed to address the increasingly complex health care needs of our citizens and to expand the pool for future faculty and advanced practice nurses. North Carolina must create new partnerships between community colleges and universities to support seamless progression toward a baccalaureate degree. The RIBN model provides one option to meet this goal.

Evidence-based transition to practice: developing a model for North Carolina.

To enhance patient safety and increase retention of new nurses, structures and processes should be developed to ensure that newly licensed nurses are afforded the opportunity to gain confidence and competence as they enter the workforce. This commentary provides an overview of the work performed to date in North Carolina to build an evidence-based transition-to-practice model.

Cardiac e-learning: Development of a web-based implantable cardioverter defibrillator educational system.

OBJECTIVE: The objective of this study was to design a Web-based implantable cardioverter defibrillator (ICD) module that would allow greater access to learning which could occur at an individual's convenience outside the fast-paced clinical environment. MATERIALS AND METHODS: A Web-based ICD software educational program was developed to provide general knowledge of the function of the ICD and the interpretation of the stored electrocardiograms. This learning tool could be accessed at any time via the Columbia University Internet server, using a unique, password protected login. A series of basic and advanced ICD terms were presented using actual ICD screenshots and videos that simulated scenarios the practitioner would most commonly encounter in the fast-paced clinical setting. To determine the usefulness of the site and improve the module, practitioners were asked to complete a brief (less than 5 min) online survey at the end of the module. RESULTS: Twenty-six practitioners have logged into our Web site: 20 nurses/nurse practitioners, four cardiac fellows, and two other practitioners. The majority of respondents rated the program as easy to use and useful. CONCLUSION: The success of this module has led to it becoming part of the training for student nurse practitioners before a clinical electrophysiology rotation, and the module is accessed by our cardiac entry level fellows before a rotation in the intensive care unit or electrophysiology service. Remote electronic arrhythmia learning is a successful example of the melding of technology and education to enhance clinical learning.

Kinetic analysis of human enzyme RDH10 defines the characteristics of a physiologically relevant retinol dehydrogenase.

Human retinol dehydrogenase 10 (RDH10) was implicated in the oxidation of all-trans-retinol for biosynthesis of all-trans-retinoic acid, however, initial assays suggested that RDH10 prefers NADP(+) as a cofactor, undermining its role as an oxidative enzyme. Here, we present evidence that RDH10 is, in fact, a strictly NAD(+)-dependent enzyme with multisubstrate specificity that recognizes cis-retinols as well as all-trans-retinol as substrates. RDH10 has a relatively high apparent K(m) value for NAD(+) (~100 microm) but the lowest apparent K(m) value for all-trans-retinol (~0.035 microm) among all NAD(+)-dependent retinoid oxidoreductases. Due to its high affinity for all-trans-retinol, RDH10 exhibits a greater rate of retinol oxidation in the presence of cellular retinol-binding protein type I (CRBPI) than human microsomal RoDH4, but like RoDH4, RDH10 does not recognize retinol bound to CRBPI as a substrate. Consistent with its preference for NAD(+), RDH10 functions exclusively in the oxidative direction in the cells, increasing the levels of retinaldehyde and retinoic acid. Targeted small interfering RNA-mediated silencing of endogenous RDH10 or RoDH4 expression in human cells results in a significant decrease in retinoic acid production from retinol, identifying both human enzymes as physiologically relevant retinol dehydrogenases. The dual cis/trans substrate specificity suggests a dual physiological role for RDH10: in the biosynthesis of 11-cis-retinaldehyde for vision as well as the biosynthesis of all-trans-retinoic acid for differentiation and development.

Selective phosphorylation of antiviral drugs by vaccinia virus thymidine kinase.

The antiviral activity of a new series of thymidine analogs was determined against vaccinia virus (VV), cowpox virus (CV), herpes simplex virus, and varicella-zoster virus. Several compounds were identified that had good activity against each of the viruses, including a set of novel 5-substituted deoxyuridine analogs. To investigate the possibility that these drugs might be phosphorylated preferentially by the viral thymidine kinase (TK) homologs, the antiviral activities of these compounds were also assessed using TK-deficient strains of some of these viruses. Some of these compounds were shown to be much less effective in the absence of a functional TK gene in CV, which was unexpected given the high degree of amino acid identity between this enzyme and its cellular homolog. This unanticipated result suggested that the CV TK was important in the mechanism of action of these compounds and also that it might phosphorylate a wider variety of substrates than other type II enzymes. To confirm these data, we expressed the VV TK and human TK1 in bacteria and isolated the purified enzymes. Enzymatic assays demonstrated that the viral TK could efficiently phosphorylate many of these compounds, whereas most of the compounds were very poor substrates for the cellular kinase, TK1. Thus, the specific phosphorylation of these compounds by the viral kinase may be sufficient to explain the TK dependence. This unexpected result suggests that selective phosphorylation by the viral kinase may be a promising new approach in the discovery of highly selective inhibitors of orthopoxvirus replication.