N-glycosylation profiling of plasma provides evidence for accelerated physiological aging in post-traumatic stress disorder.

The prevalence of age-related diseases is increased in individuals with post-traumatic stress disorder (PTSD). However, the underlying biological mechanisms are still unclear. N-glycosylation is an age-dependent process, identified as a biomarker for physiological aging (GlycoAge Test). To investigate whether traumatic stress accelerates the aging process, we analyzed the N-glycosylation profile in n=13 individuals with PTSD, n=9 trauma-exposed individuals and in n=10 low-stress control subjects. Individuals with PTSD and trauma-exposed individuals presented an upward shift in the GlycoAge Test, equivalent to an advancement of the aging process by 15 additional years. Trauma-exposed individuals presented an intermediate N-glycosylation profile positioned between severely traumatized individuals with PTSD and low-stress control subjects. In conclusion, our data suggest that cumulative exposure to traumatic stressors accelerates the process of physiological aging.

Transforming healthcare: a safety imperative.

Ten years ago, the Institute of Medicine reported alarming data on the scope and impact of medical errors in the US and called for national efforts to address this problem. While efforts to improve patient safety have proliferated during the past decade, progress toward improvement has been frustratingly slow. Some of this lack of progress may be attributable to the persistence of a medical ethos, institutionalized in the hierarchical structure of academic medicine and healthcare organizations, that discourages teamwork and transparency and undermines the establishment of clear systems of accountability for safe care. The Lucian Leape Institute, established by the US National Patient Safety Foundation to provide vision and strategic direction for the patient safety work, has identified five concepts as fundamental to the endeavor of achieving meaningful improvement in healthcare system safety. These five concepts are transparency, care integration, patient/consumer engagement, restoration of joy and meaning in work, and medical education reform. This paper introduces the five concepts and illustrates the meaning and implications of each as a component of a vision for healthcare safety improvement. In future roundtable sessions, the Institute will further elaborate on the meaning of each concept, identify the challenges to implementation, and issue recommendations for policy makers, organizations, and healthcare professionals.

Pro-patient partnerships.

The degree to which nurses and physicians collaborate greatly impacts patient care. These elements of effective partnerships and strategies can help you achieve mutual benefits.

Beyond utilization control: managing care with customers.

Allina Health System embarked on a rigorous process to better understand the customer's perception of care and service. The milestone for quality is the participation of the patient, member, and family in the health care system to determine care and service quality. The challenge for those in health care is to understand and manage the complex cultural changes this inclusion implies.

Image enhancement. Developing a program for perioperative nurses.

An image campaign focuses on the strengths of nurses to promote nursing, and in doing so, helps nurses rediscover the values and commitment that are at the heart of the profession. Nursing's image will change when nurses themselves change.

A missing consideration: the psychiatric patient classification for scheduling-staffing systems.

The psychiatric nursing department at a university teaching hospital identified the need to develop a management tool to systematically and objectively determine resource requirements (staffing) for unique psychiatric patient populations. A classification methodology was needed for budget development, trending, productivity monitoring, and potentially developing a rich data base for nursing research. A study of existing classification systems found them to be limited for use in psychiatric settings. The psychiatric nursing department designed and implemented a patient classification tool based on biopsychosocial needs manifested by psychiatric patients in acute care settings.

Evaluating very small and rapidly evolving programs. Consultation in the case of a health careers information program.

The case of a health careers program evaluation illustrates some aspects of evaluating very small and rapidly evolving programs. Such programs can change quickly, since there is no massive bureaucracy to restrain them. Rigid evaluation research methods would frustrate both researchers and program staff. The authors suggest that flexible design, use of specialized interviewing and analytical experiments--in this case, telephone surveys testing program response--and a recognition that a consultative relationship exists will result in outcomes useful to the program and rich in evaluation data.

Theory-based intervention: a case study using Sullivan's interpersonal theory of psychiatry.

The essence of the schizophrenic dynamism is a confusion in the interpersonal relations by the appearance in awareness of referential processes ordinarily excluded from awareness (Sullivan, 1956; 361). Its etiology can be traced to a pathological symbiotic relationship with the mothering one in which there is an overwhelming degree of anxiety transmitted to the infant. A consistent, frequent, nonthreatening and non-demanding approach is the basis for all nursing interventions. The emphasis of treatment is on identifying and strengthening the patient's assets and raising self-esteem. Interventions are directed toward the patient's resocialization and reality-testing. Staff effort is required to create a milieu in which it is desirable and possible for patients to learn autonomy. Patients should be encouraged to look at their feelings in the light of their past experiences, but with a recognition that the past is over and beyond their control. What happens in the future depends on their efforts now. Finally, nurse-therapists need to be secure, thoughtful, and empathic in treating schizophrenic patients. The challenge for staff is to be absolutely consistent and communicate acceptance and positive regard whatever the patients' behavior.