Cardiopulmonary Telerehabilitation.

Cardiopulmonary telerehabilitation is a safe and effective alternative to traditional center-based rehabilitation. It offers a sustainable solution to more conveniently meet the needs of patients with acute or chronic, preexisting or newly acquired, cardiopulmonary diseases. To maximize success, programs should prioritize basic, safe, and timely care options over comprehensive or complex approaches. The future should incorporate new strategies learned during a global pandemic and harness the power of information and communication technology to provide evidence-based patient-centered care. This review highlights clinical considerations, current evidence, recommendations, and future directions of cardiopulmonary telerehabilitation.

Expanding Virtual Reality to Teach Ultrasound Skills to Nurse Practitioner Students.

This team has had prior successful production efforts in the use of Second Life to implement a virtual reality world into both nursing education and practice. Our current efforts center around a virtual reality application that provides learners with the opportunity to master competencies in the use of ultrasound technologies, which have surfaced in many nurse practitioner certifications as a necessary skill. Using the authoring tool of CenarioVR™, and capturing video footage of a nurse practitioner using the ultrasound equipment, students can don a VR headset for an immersive experience. This ultrasound equipment is expensive, and allowing learners to learn skills in a virtual environment poses less risk to both the equipment and the patients.Future production efforts in augmented and mixed reality applications are described to engage others in cutting edge use of VR.

Designing New Buildings to Accommodate Current Technologies.

Growing higher educational programs are always interested in adding physical facilities to their campus. Many times the initial plans do not include all the technology details needed for either a standard or a cutting-edge program. This paper describes planning and implementation efforts at the Vanderbilt University School of Nursing, which has resulted in a new 29,947-square-foot facility addition. The new space includes a complete floor designated as simulation laboratory space, an interactive classroom with five screens suitable for small group interaction, and a virtual classroom for cutting- edge multimedia production and transmission. Additional floors house both technology rich seminar meeting rooms as well as collaborative offices. All spaces are integrated using the innovative Crestron control system, including a multitude of their solutions that help to make this a smarter workplace that is both secure, smart, and worthy of completing educational goals.

Using Contemporary e-Learning Tools to Teach Staff How to Use New Online Documentation Systems.

Medical centers, hospitals, and health care practices are implementing electronic documentation systems and regularly adding new features to these systems. Training users to effectively use these systems in a scalable way has been a challenge. Learners learn at different rates and have different needs. While traditional face to face instruction has been the gold standard, eLearning technologies can provide acceptable alternatives. This poster will demonstrate three eLearning methodologies for training.

Twenty Plus Years of Distance Learning: Lessons Learned.

Private institutions of higher education in the United States were hesitant to institute programs of distance learning for fear that they could not maintain the quality of the education they had delivered in face-to-face programs. Vanderbilt University allowed their School of Nursing to embark on such an endeavor in 1996, as long as quality measures were incorporated. The result has been a comprehensive resource support team using Quality Matters and an increase in program rankings.

Using the Virtual Reality World of Second Life to Promote Patient Engagement.

Patients have typically been passive participants in their own healthcare. However, with a change in philosophy towards outcomes driven care, it has become necessary to make sure that patients mutually set their healthcare goals with their providers Both eHealth and mobile health applications have required patient participation in ways never before valued. The virtual reality world of Second Life offers one eHealth solution that requires computer literate patients to participate via avatars in synchronous healthcare visits and support groups, as well as explore online resources asynchronously. This paper describes the development of a Second Life environment that served as a platform for nurse practitioner driven care supplemented by a patient portal as well as the institutional electronic health record. In addition, the use of Second Life is described as an active exercise to expose students in a Consumer Health course to support groups and resources available to actively engage patients.

Integrating Informatics Content into the Nursing Curriculum.

Contemporary nursing curricula require that nursing informatics content be integrated across the various levels of the programs that are offered. Many such programs face national accreditation requirements that typically relate more to technology than to informatics. International standards vary in these requirements. How can nursing programs meet these vastly different criteria yet continue to level informatics content that follows quality curriculum standards? This presentation describes one approach across programs that considers already developed competencies in nursing informatics while also taking into consideration the various roles that the graduates will have to assume in advanced practice nursing roles. Levels discussed include the baccalaureate, master's, doctorate in nursing practice, and the traditional Doctor of Philosophy degrees.

Distance Education Programs: The Technical Support to Be Successful.

Academic success requires support on a variety of levels as well as access to contemporary tools and services. Supporting students enrolled in a successful higher education distance learning program, requires a strong, properly trained IT support staff in addition to a stable IT environment. Our distance education program began with a regional market but has grown significantly over the past few years. This is primarily due to the success of our distance education tools and support which have contributed to achieving a ranking of eleventh of best graduate schools in nursing according to the U.S. News and World Report. The entire student population is "Bring Your Own Devices" (BYOD). Critical to this support is the initial configuration and loading of needed software during the first week of orientation. All of this success requires a robust team of members prepared in a range of skill sets from networking to instructional design.

Characterization of immune cells in psoriatic adipose tissue.

BACKGROUND: Adipose tissue normally contains immune cells that regulate adipocyte function and contribute to metabolic disorders including obesity and diabetes mellitus. Psoriasis is associated with increased risk for metabolic disease, which may in part be due to adipose dysfunction, which has not been investigated in psoriasis. There is currently no standardized method for immunophenotyping human adipose tissue. In prior studies, characteristic phenotypic markers of immune cell populations identified in animal models or in other human tissues have been applied in a similar manner to human adipose tissue. Rarely have these populations been verified with confirmatory methodologies or functional studies. Thus, we performed a comprehensive phenotypic and functional analysis of immune cell populations in psoriatic adipose tissue. METHODS: Conventional and imaging flow cytometry were used to define immune cell populations in biopsy specimens of psoriatic adipose tissue (n = 30) including T cells, B cells, NK cells, NKT cells, neutrophils, and macrophages. Relationships between adipose immune cell types and body mass index were determined using Spearman regression analysis, and multivariate linear regression analysis was performed to adjust for cardiometabolic disease risk factors. RESULTS: These analyses revealed a wide range of cell surface receptors on adipose tissue macrophages, which may serve a dual purpose in immunity and metabolism. Further, both CD16+CD56(Lo) and CD16-CD56(Hi) NK cells were found to correlate inversely with body mass index. The relationship between the predominant CD16+CD56(Lo) NK cell population and body mass index persisted after adjusting for age, sex, diabetes, and tobacco use. CONCLUSIONS: Together, these studies enhance our understanding of adipose immune cell phenotype and function, and demonstrate that examination of adipose tissue may provide greater insight into cardiometabolic pathophysiology in psoriasis.

The role of technology and informatics in disaster planning and response.

It is clear that technology and informatics are becoming increasingly important in disasters and humanitarian response. Technology is a critical tool to recording, analyzing, and predicting trends in data that could not be achieved prior to its implementation. Informatics is the translation of this data into information, knowledge, and wisdom. Combining technology and informatics applications with response efforts has resulted in various enhanced biosurveillance efforts, advanced communications, and information management during disasters. Although these efforts have been well described in the literature, research on the impact of technology and informatics during these efforts has been limited. As a result, this chapter will provide an overview of these technology and informatics solutions and present suggestions for further research in an era when disaster and humanitarian response efforts continue to increase as well. A literature search was performed using PubMed search tools with the National Library of Medicine Medical Subject Headings (MeSH) terms of "disasters," "disaster planning," "disaster medicine," "technology," "informatics," and "research." Search limitations were set for 5 years and in English. Because of the limited number of research articles in this field, the MeSH term research was deleted.

Extending nurse practitioner care using the virtual reality world of second life.

The growth of Internet applications has substantially broadened the potential for its use in global telehealth. This pilot project used the virtual reality world of Second Life for diabetic patients to meet with their nurse practitioners for their maintenance visits. Using avatars and the online patient portal, these scheduled visits were designed to meet the needs of the patients as determined by the results from a questionnaire completed by patients prior to the visit. The virtual visits took place in the replicated building where patients typically receive their care, the Eskind Diabetes Clinic. Orientation sessions to Second Life were made available prior to the actual visit, and additional online resources were made available after the visit was over. Although only seven pilot patients have currently completed visits, data illustrate the positive potential use of this treatment modality for future study.

Research issues for nursing and midwifery contributions in emergencies.

This special report was prepared as a white paper for the First World Health Organization (WHO) Consultation on Nursing and Midwifery Contributions in Emergencies held in Geneva on 22-24 November 2006. Pertinent issues related to research of nurses and midwives were identified based on prior international conferences. Using this information, gaps between the current and proposed state of preparedness research activities were identified. Global perspective recommendations were made for consideration by the WHO and other nursing organizations. Finally, possible discussion questions were posed that were used during the consultation, but could also be used in other international nursing conferences.

Using the virtual reality world of second life to teach nursing faculty simulation management.

Healthcare faculty members have come to depend on the advantages of teaching with clinical simulation, but not all faculty are competent in their ability to manage students during the simulation experience. This federally funded proposal provided the opportunity for nursing faculty to participate in a synchronous learning event using the virtual reality world of Second Life (SL). Based on competencies, faculty participants were guided through the simulation process by a "Master Teacher." Participants then became the teacher and chose the settings, objectives, and clinical data to manage their own simulation using avatar role assignments. Feedback populated the participant informatics dashboard, so that progress towards their competencies was recorded. Another unique informatics application was the use of the Synthetic Derivative project to use de-identified patient data to promote better clinical realism. Additional evaluation activities regarding content, appropriate use of the technology, and design features were assessed. The development of the SL environment for this educational study provides the setting in which to pilot test the provision of actual clinical care that does not require "hands-on" interventions.

Teaching during a pandemic event: are universities prepared?

As the threat of pandemic events streaks across the planet, the question then becomes can universities, particularly health science centers charged with producing the next generation of health care providers, continue their teaching and educational mission by offering classes in a distance environment, completely uncentralized, away from the traditional centralized campus? A sampling of campus websites were reviewed to gather a sense of how well prepared we are, followed up with a survey administered to faculty and staff in the School of Nursing at Vanderbilt University. The concern being that if a technology rich environment such as Vanderbilt is not fully prepared to continue teaching in a pandemic event, what concerns should we have for other institutions providing health care provider education that may not have access to the resources a Vanderbilt has? Finally, a set of recommendations to schools is presented, based on the findings.

An analysis of nursing education's immersion into Second Life, a multi-user virtual environment (MUVE).

Second Life (SL) is a multi-user virtual environment (MUVE) using 3-D modeling to replicate real world settings and experiences. However, little is known of the extent to which nursing education is involved in SL activities. This study used four different search strategies to conduct a comprehensive review of print, blog, web and media sources. Twenty-nine unique nursing communities, groups or educational activities were identified. This study identified a number of barriers identified that made the analysis both difficult and time-consuming. Two main categories emerged: explorers and developers. The explorers used SL for a support group, networking, and uncovering health-related sites. The developers were associated with land ownership and were involved in distance learning and simulation activities. Seven unique simulations for nursing education were identified. Given the number of registered users, the number of universities currently involved in SL, the availability of health-related sites for consumers, and the emerging interest in telehealth in SL substantial growth in the use of SL in nursing education is likely.

Nursing informatics for future nurse scholars: lessons learned with the doctorate of nursing practice (DNP).

The addition of the DNP created challenges that resulted in a re-evaluation of the leveling of informatics competencies across the nursing curriculum. The knowledge and skills needed by informatics nurse specialists was differentiated from those needed by three levels of nurses (entry level practitioner, advanced practice nurse, and nurse scholar (both PhD and DNP)). After a thorough review of the literature and examination of various competencies and definition for nursing informatics, a new model was proposed and guided the creation and implementation of a core course in informatics for DNP students.

The emerging role of educational informatics.

Initial growth in the field of nursing informatics has centered primarily on the clinical setting. Much has been written about the systems developed and evaluated and possible new roles that one can play in the clinical environment. The educational arena has not fared as well. Early attention has been focused on the integration of educational technology or on competency-based skills in informatics according to program levels of students. This paper will focus on the emerging role of educational informatics. Examples will provide nurses with a better understanding of the roles played by the educational informaticist in crafting the science of nursing informatics to produce better nursing education outcomes.

Risk of hand-foot skin reaction with the multitargeted kinase inhibitor sunitinib in patients with renal cell and non-renal cell carcinoma: a meta-analysis.

Hand-foot skin reaction (HFSR) is an emerging issue in cancer treatment with multitargeted tyrosine kinase inhibitors (TKIs), leading to morbidity, suboptimal dosing, and poor compliance. The overall risk of HFSR is not clear for sunitinib, a TKI effective for metastatic renal cell carcinoma (RCC) and gastrointestinal stromal tumor. We therefore conducted a systematic review and a meta-analysis to determine the risk of developing HFSR with sunitinib. Databases from PubMed and Web of Science for articles from July 1966 until July 2007 and abstracts presented at the American Society of Clinical Oncology conferences were searched to identify relevant studies. Eligible studies were prospective clinical trials that had described events of HFSR for patients who received singleagent sunitinib. Incidence and relative risk (RR) were calculated using a random-effects or fixed-effects model. A total of 5005 patients with RCC and other cancers from 10 clinical trials were included for analysis. Among patients receiving sunitinib, the summary incidences of all-grade and high-grade HFSR were 18.9% (95% CI, 14.1%-24.8%) and 5.5% (95% CI, 3.9%-7.9%), respectively. Interestingly, patients with RCC have significantly decreased risk of HFSR compared with patients with non-RCC malignancy (RR, 0.56; 95% CI, 0.50-0.64; P < .001). In addition, sunitinib was associated with a significantly increased risk of all-grade HFSR (RR, 9.86; 95% CI, 3.1-31.31; P < .001) in comparison with controls. There is a significant risk of developing HFSR in patients with cancer receiving sunitinib. Adequate monitoring and intervention are recommended for reducing the toxicity.

Supporting the integration of technology into contemporary nursing education.

This article provides an overview of the challenges and strategies faced by educational administrators in planning, delivering, and evaluating technology services to today's nursing students and faculty. Academic technology uses, examples, and support suggestions are provided so that educational administrators can effectively choose appropriate technologies geared to meet their educational objectives. The challenge comes with deciding the intended educational outcomes, and designing the appropriate educational milieu. Administrators are reminded to look to central administration to coordinate and participate in technology planning.