Interface of Clinical Nurse Specialist Practice and Healthcare Technology.

PURPOSE: This article demonstrates the leadership role of the clinical nurse specialist in developing and implementing healthcare technology across the continuum of care. DESCRIPTION: Three virtual nursing practices-facilitated self-care, remote patient monitoring, and virtual acute care nursing-illustrate how the clinical nurse specialist is well suited to transform traditional practice models to ones that use healthcare technology effectively. These 3 practices use interactive healthcare technology to gather patient data and allow communication and coordination with the healthcare team to meet patient-specific needs. OUTCOME: Use of healthcare technology in virtual nursing practices led to early care team intervention, optimized care team processes, proactive patient outreach, timely access to care, and reduction in healthcare-associated errors and near-miss events. CONCLUSION: Clinical nurse specialists are well positioned to develop innovative, effective, accessible, and high-quality virtual nursing practices. Integrating healthcare technology with nursing practice augments care for various patients, ranging from those with low illness severity in the outpatient setting to acutely ill patients in the inpatient hospital environment.

Initiating Virtual Nursing in General Inpatient Care.

ABSTRACT: With increased demands for inpatient care and limited nursing resources, bedside RNs at one health care system were challenged to find experienced nurse colleagues to provide mentorship when they needed assistance in executing best practices. A virtual RN (ViRN) role was created to support bedside RNs and patients on designated general care inpatient units. The ViRN provided real-time virtual clinical guidance to bedside RNs and actively surveilled patients. Bedside RNs were surveyed by email to gauge the utility and their perceptions of integrating ViRNs into the nursing care team. RNs reported that they valued the consistent availability of having the ViRNs' expert nursing knowledge and virtual assistance with nursing tasks.

Interaction Between Progesterone and Interleukin-1ß in Modulating Progesterone Receptor Expression and the Inflammatory Phenotype in Human Cervical Fibroblasts.

Progesterone helps maintain cervical structure during pregnancy via the progesterone receptor (PR). Two PR isoforms exist, PR-A and PR-B, which have overlapping as well as isoform-specific target genes. During late gestation, leukocytes infiltrate the cervical stroma accompanied by increased cervical cytokine levels, resembling an inflammatory process. We examined interleukin (IL)-1ß regulation of the expression of PR-A, PR-B, and genes governing prostaglandin synthesis in human cervical fibroblasts (HCFs). Since progesterone has been shown to exert anti-inflammatory actions, we also examined the capacity of progesterone (R5020) to ameliorate the actions of IL-1ß in HCFs. Interleukin-1ß induced both PR-A and PR-B mRNA in HCFs. Interleukin-1ß induced a rapid and transient loss of both PR-A and PR-B protein, followed by a latent (24 hours) increase in both PR isoforms. R5020 negated the IL-1ß-induced increase in PR-A and PR-B mRNA and protein as well as the rapid IL-1ß-induced downregulation of nuclear PR. Interleukin-1ß induced prostaglandin G/H synthase-2 (PGHS-2), but not prostaglandin G/H synthase-1 (PGHS-1), as well as prostaglandin E synthase-1 (PGES-1), but not prostaglandin F synthase (PGFS). R5020 did not ameliorate IL-1ß induction of PGHS-2 or PGES-1. Blockade of prostaglandin synthesis (indomethacin) prevented both the IL-1ß-induced increase in PR mRNA and the acute decrease in PR-A and PR-B protein, implicating a role for prostaglandins in regulating PR expression in HCFs. Although progesterone may function to maintain PR expression in a milieu of increasing cytokines in the late gestation human cervix, it does not exert an anti-inflammatory role with regard to prostaglandin E2 (PGE2) production.

Interleukin 1ß regulates progesterone metabolism in human cervical fibroblasts.

Progesterone plays a critical role in regulating cervical structure necessary for pregnancy maintenance. Preterm labor and early cervical ripening are often associated with localized infection. We hypothesized that proinflammatory cytokines enhance progesterone metabolism in human cervical fibroblasts (HCFs) in vitro, through the regulation of the expression of 20α-hydroxysteroid dehydrogenases (aldo-keto reductase [AKR]1C1, AKR1C2, or AKR1C3), 5α-reductase type 1 (5α-RDT1), and/or 17ß-hydroxysteroid dehyrogenases (17ß-HSD) type 1 and 2. The expression of both progesterone receptor (PR) and estrogen receptor α (ERα) was also studied. Human cervical fibroblasts were found to express AKR1C1, C2, and C3, with AKR1C1 exhibiting the greatest expression. These cells also expressed 5α-RDT1 and 17ß-HSD1 and 2, albeit to a lesser level compared to the aldo-keto reductases. The fibroblasts also expressed both PR and ERα. Interleukin 1ß (IL-1ß) significantly increased the expression of AKR1C1 and C2 but not C3 but did not alter 5α-RDT1 nor 17ß-HSD1 or 2 expression. Interleukin 1ß treatment significantly increased progesterone metabolism by these cells. Use of specific inhibitors for aldo-keto reductases or 5α reductases confirmed that the increased progesterone metabolism was a consequence of the increased expression and/or activity of AKR1C1/2. Our results indicate that a major proinflammatory cytokine, IL-1ß, can facilitate local progesterone metabolism in a cell type critical for maintaining cervical structure via regulating expression of AKR1C1 and 2.