Ventral striatal regulation of CREM mediates impulsive action and drug addiction vulnerability.

Impulsivity, a multifaceted behavioral hallmark of attention-deficit/hyperactivity disorder (ADHD), strongly influences addiction vulnerability and other psychiatric disorders that incur enormous medical and societal burdens yet the neurobiological underpinnings linking impulsivity to disease remain poorly understood. Here we report the critical role of ventral striatal cAMP-response element modulator (CREM) in mediating impulsivity relevant to drug abuse vulnerability. Using an ADHD rat model, we demonstrate that impulsive animals are neurochemically and behaviorally more sensitive to heroin and exhibit reduced Crem expression in the nucleus accumbens core. Virally increasing Crem levels decreased impulsive action, thus establishing a causal relationship. Genetic studies in seven independent human populations illustrate that a CREM promoter variant at rs12765063 is associated with impulsivity, hyperactivity and addiction-related phenotypes. We also reveal a role of Crem in regulating striatal structural plasticity. Together, these results highlight that ventral striatal CREM mediates impulsivity related to substance abuse and suggest that CREM and its regulated network may be promising therapeutic targets.

Critical care nurses' perceptions of family needs as met.

In this descriptive, exploratory study, nurses' perceptions of family needs as met during the critical care experiences of an adult member were correlated to the families' perception of those same needs as being met. The population consisted of 45 family members in a large county hospital designated as a Level 3 trauma center. Family members of adult patients and registered nurses who were assigned to care for them completed a three-part instrument, which consisted of the Demographics Data Questionnaire, the Critical Care Family Needs Inventory (CCFNI), and the Needs Met Inventory (NMI). Data were analyzed using descriptive and inferential statistics. The top 10 needs perceived by the family members and registered nurses were reported in order of importance during the first 18-24 hours on the CCFNI and NMI. Data were analyzed on all 45 need statements to determine the top 10 needs perceived as important on the CCFNI and perceived as being met on the NMI. A one-way analysis of variance (ANOVA) test was performed on the data and yielded significant differences on three of the items. Linear regression was performed using t test which supported a significant difference on five statements based on critical care nursing years of experiences in critical care. Self-reported or open-ended comments from the family members and nurses were presented.

Perceived and unmet needs of critical care family members.

Family members of patients in the intensive care unit (ICU) may experience stress, disorganization, and helplessness which may ultimately result in difficulty in mobilizing appropriate coping resources, thus leading to anxiety. The needs of family members are varied, and critical care nurses must become attuned to these needs and acquire the skills to direct their interventions more appropriately. This article presents the findings from a study that assessed the perceived level of importance of the needs of family members during the first 18 to 24 hours after admission to the ICU using the Critical care Family Needs Inventory. The study identified which needs were perceived as being met or unmet by the family members using the Needs Met Inventory after 36 to 48 hours had elapsed.

Bereavement care in the critical care setting.

Bereavement care in critical care units should involve providing support and counseling for the family members prior to death, immediately after the death has occurred, and at least some follow-up in the future months. These are crucial moments: Once the death has occurred, the family members status changes from anticipatory to bereaved status.

Issues in conducting research with vulnerable families.

This article explores methodological and ethical issues in the conduct of research with vulnerable families. Some methodological and ethical issues are common to all family research, regardless of the families' vulnerability; however, many research issues are more problematic in vulnerable families, and a few issues are relatively unique to vulnerable families. Vulnerable families are defined as families that are susceptible to harm because of their socioeconomic status, their minority status, or other stigmatizing status. Methodological issues include definition of family; recruitment and retention of participants; reliability and validity of instruments; and racism, classism, and sexism. Ethical issues include confidentiality, reporting abuse and neglect, conflict of research ethics and personal ethics, identifying problems nobody can fix, balancing demands and benefits, and interpretation of data. Examples of methodological and ethical issues are drawn from several research studies in which the primary author was or is currently involved.

The phenomena of nurses' caring behaviors as perceived by the critical care family.

Few studies have comprehensively focused on caring as perceived by the critical care family. This study explores and describes positive types of nurses' behaviors and critical care families' perceptions of these nursing behaviors as caring. Grounded theory methodology was used to enter the world of the critical care family and to elicit the meanings of caring behaviors in nurse-family interactions in the critical care waiting room.

Perceived needs of the family members in the critical care waiting room.

Family needs during the critical care experience of an adult member was the focus of this descriptive exploratory study conducted with 94 family members. The study describes the perceived needs of family members during the first 18 to 24 hours after admission of a patient to the critical care unit. The article further identifies the order in which the family perceived those needs to be met 36 to 48 hours after admission of that patient. Family members of adult patients completed a three-part instrument, which consisted of the Demographics Data Questionnaire, the Critical Care Family Needs Inventory (CCFNI), and the Needs Met Inventory (NMI). Items with which the family strongly agreed are discussed. The correlation between the CCFNI and the NMI is explicated. Also, the unusual finding of an inverse relationship between education and comfort/support statements is presented.