A Compendium of Clinical Nurse Specialist Roles in a Canadian Health Authority.

Interior Health in British Columbia advocates for and supports advanced practice nurses, inclusive of regional clinical nurse specialists (CNSs). CNSs develop evidence-informed programs, education, policies and practice standards. The article uses an advanced practice nursing framework to anchor two case studies: (1) the operationalization and implementation of a regional CNS role in primary care and (2) the use of a knowledge translation strategy to build clinical capacity in serious illness conversations. These case studies embody the CNS role and provide a voice for CNSs to communicate the ways in which their advanced practice nursing role is pivotal in healthcare system transformation and for providing quality patient care.

Pitching people with an inversion table: Estimates of body orientation are tipped as much as those of visual surfaces.

In the current work we investigate people's perception of their own body tilt in the pitch direction. In Experiment 1, we tilted people backward at 1 of 5 different randomly assigned angles using an inversion table. People significantly overestimated the angle at which they were tilted backward at angles from 8° to 45°. The slope of the plotted average overestimates had a gain of 1.46, fitting nicely with previously reported gains of verbal overestimates of visually perceived slant of natural outdoor geographically oriented slopes as well as man-made wooden slopes within and outside of reach in the laboratory. In Experiment 2, we showed participants a 45° line and asked them to indicate when they were positioned at that orientation. Participants again significantly overestimated the angle at which they were tilted backward. This extends work showing that a scale-expanded theory of visual space is multisensory, results in equivalent estimates for both verbal and nonverbal/nonnumeric methods, and can now be expanded to include the perceived orientation of one's own body.

Palm board and verbal estimates of slant reflect the same perceptual representation.

People verbally overestimate the orientation of slanted surfaces, but accurately estimate or underestimate slanted surfaces using a palm board. We demonstrate a fundamental issue that explains why the two different values typically given for palm board and verbal/visual matching estimates express similar perceptual representations of slanted surfaces. The fundamental problem in studies measuring palm board and verbal estimates is that the "measure"-either (1) reproducing a verbally given angle or the orientation of a slanted surface with an unseen hand or (2) verbally or visually estimating a visually perceived surface-has always been confounded with the "surface"-either using (1) a palm board or (2) a hill or ramp. Although reproduction has exclusively been used with palm boards in these studies, at the same time verbal estimation or visual matching has exclusively been used with hills/ramps. In three experiments, we showed that verbally estimating palm board orientations produces overestimates by a factor of 1.5, whereas reproducing the orientation of the surface of a ramp to verbally given angles produces gains of ~0.6. These values are similar to those seen for verbal overestimates of slanted surfaces, and to palm board gains for near surfaces and the relative palm-board-to-verbal gains for outdoor hills, respectively. Eliminating this confound eliminated the difference previously seen across surfaces. We discuss how and why different measures should produce different results if we overestimate slant in general and perceptually represent slant in the same way, both haptically and visually.

Herpes simplex virus type 2 infection in young adult women: risk factors for infection and frequency of viral shedding.

BACKGROUND: Population-based studies suggest that acquisition of herpes simplex virus 2 (HSV 2) is most common between ages 20 and 29, especially in minority women. We examined HSV 2 infection and viral shedding in a cohort of young women. METHODS: Women, age 18 to 24 (median 21), who were part of an observational cohort enrolled between ages 14 to 17, had blood obtained for HSV 2 antibody. Intensive diary collections on sexual behavior and genital symptoms and weekly vaginal swabs were obtained at regular intervals. RESULTS: HSV 2 antibodies were detected in 43 of 127 participants (33.9%), only 4 of whom were previously known to be positive. Factors associated with a positive test included older age, years of sexual activity, and number of lifetime partners. Testing for HSV 2 DNA by polymerase chain reaction on weekly vaginal swabs from a 13-week sampling period for each HSV 2 antibody positive participant showed 32 of 43 (74.4%) were positive at least once. The positive predictive value of pain for viral shedding was poor. CONCLUSIONS: HSV 2 infection is very common among young adult women, but symptomatic genital herpes is not. Shedding of HSV 2 DNA can be detected in most antibody positive persons. Early intervention strategies will be needed to control HSV 2 infection.

Primary percutaneous coronary angioplasty with and without eptifibatide in ST-segment elevation myocardial infarction: a safety and efficacy study of integrilin-facilitated versus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction (ASSIST).

BACKGROUND: Primary percutaneous coronary intervention, if performed promptly, is the preferred strategy to restore flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. We sought to determine whether eptifibatide, a platelet glycoprotein IIb/IIIa inhibitor, given before catheterization would improve clinical outcomes in patients referred for primary percutaneous coronary intervention. METHODS AND RESULTS: We randomly assigned a total of 400 patients with ST-segment elevation myocardial infarction referred for primary percutaneous coronary intervention to treatment initiated before cardiac catheterization, with either heparin plus eptifibatide (201 patients) or heparin alone (199 patients), in addition to oral aspirin (160 mg) and high-dose clopidogrel (600 mg). The primary end point was a composite of death from any cause, recurrent myocardial infarction, or recurrent severe ischemia during the first 30 days after randomization. At 30 days, the primary end point was reached by 13 patients (6.47%) assigned to heparin plus eptifibatide and by 11 patients (5.53%) assigned to heparin alone (relative risk, 1.18; 95% CI, 0.52 to 2.70; P=0.69). The rates of major or minor bleeding were higher in patients assigned to heparin plus eptifibatide than that in patients assigned to heparin alone (22.4% versus 14.6%; relative risk, 1.69; 95% CI, 1.01 to 2.83; P=0.04). CONCLUSIONS: In patients pretreated with high-dose clopidogrel who were referred for primary PCI, treatment with heparin plus eptifibatide, when compared with heparin alone, did not improve clinical outcomes and was associated with more bleeding complications.