Nurse Executives Impacting the Human Experience in Health Care.

The human experience in health care over the past 2 and one-half years has been unprecedented. Impacted by the COVID-19 pandemic, march on the United States Capitol, economic crisis, social injustice, and growing concerns regarding structural racism-our health system is under siege. Executive nurse leaders find themselves at the crossroads of motivating colleagues to provide excellence in nursing and patient care while confronting both a current and future shortage of registered nurses.

Cultivating a Culture:: Implementing Methods to Embrace Diversity and Inclusion.

Anne Arundel Medical Center, Annapolis, Maryland, was the recipient of this year's American Organization for Nursing Leadership's Prism Award, which recognizes an organization with advanced diversity efforts. The medical center, part of Luminis Health, added diversity as a core organizational value in 2009, making efforts to provide care to diverse populations and support an inclusive work environment for staff. Through strategic initiatives and community partnerships that target recruiting efforts, the organization has created a culture in which difficult conversations about differences are supported and encouraged.

Engaging Employees in Well-Being: Moving From the Triple Aim to the Quadruple Aim.

Anne Arundel Medical Center has been on a 3-year journey to improve employee well-being with the assumption that employee well-being and employee engagement are interconnected. Improvements in employee well-being will result in increased employee engagement and will be a pivotal driver to assist the health system meet its goals. Historically, Anne Arundel Medical Center successfully differentiated itself in the market by being the region's high-quality, low-cost provider of health services delivered through intense collaboration with patients and families.

MicroRNA 155-deficiency leads to decreased autoantibody levels and reduced severity of nephritis and pneumonitis in pristane-induced lupus.

Objective: We herein examine the role of endogenous miR155 in the development of systemic manifestations in pristane induced lupus.

Materials And Methods: Systemic lupus in miR155-deficient and wild type mice was induced upon injection of pristane and analyzed after 8 months, PBS-injected mice served as controls. Glomerulonephritis and pneumonitis were quantified using the kidney biopsy score and a newly adapted histomorphometric image analysis system; lung tissue was further analyzed by tissue cytometry.

Assessment of pathology instruction in U.S. Dental hygiene educational programs.

Purpose: To assess the instruction of pathology content in entry-level and advanced practitioner dental hygiene educational programs and the program directors' perceptions whether their graduates are adequately prepared to meet the increasingly complex medical and oral health needs of the public.

Methods: A 28-question survey of instructional content and perceptions was developed and distributed using Qualtrics® software to the 340 directors of entry-level and advanced practitioner dental hygiene programs in the US. Respondents rated their level of agreement to a series of statements regarding their perceptions of graduates' preparation to perform particular dental hygiene services associated with pathology.

Enrichment of circulating melanoma cells (CMCs) using negative selection from patients with metastatic melanoma.

Circulating tumor cells have emerged as prognostic biomarkers in the treatment of metastatic cancers of epithelial origins viz., breast, colorectal and prostate. These tumors express Epithelial Cell Adhesion Molecule (EpCAM) on their cell surface which is used as an antigen for immunoaffinity capture.

Noncanonical activation of Notch1 protein by membrane type 1 matrix metalloproteinase (MT1-MMP) controls melanoma cell proliferation.

Notch1 is an evolutionarily conserved signaling molecule required for stem cell maintenance that is inappropriately reactivated in several cancers. We have previously shown that melanomas reactivate Notch1 and require its function for growth and survival. However, no Notch1-activating mutations have been observed in melanoma, suggesting the involvement of other activating mechanisms.

An innovative professional practice model: adaptation of Carper's patterns of knowing, patterns of research, and Aristotle's intellectual virtues.

Professional practice models have emerged as the way hospital-based nursing expresses its consensus-derived philosophy. Magnet recognition influences this practice, while extant nursing theories continue the quest to bridge scholarship with practice. The innovative model presented in this article is an adaptation of Carper's patterns of knowing into a nursing meta-language of science, ethics, art, and advocacy.

An ERBB3/ERBB2 oncogenic unit plays a key role in NRG1 signaling and melanoma cell growth and survival.

We recently identified neuregulin-1 (NRG1) as a novel target of Notch1 required in Notch-dependent melanoma growth. ERBB3 and ERBB4, tyrosine kinase receptors specifically activated by NRG1, have been shown to be either elevated in melanoma cell lines and tumors or to be mutated in 20% of melanomas, respectively. While these data support key roles of NRG1 and its receptors in the pathogenesis of melanoma, whether ERBB3 and ERBB4 display redundant or exclusive functions is not known.

Thrombospondin-1 expression in melanoma is blocked by methylation and targeted reversal by 5-Aza-deoxycytidine suppresses angiogenesis.

Background: Reversibility of aberrant methylation via pharmacological means is an attractive target for therapies through epigenetic reprogramming. To establish that pharmacologic reversal of methylation could result in functional inhibition of angiogenesis, we undertook in vitro and in vivo studies of thrombospondin-1 (TSP1), a known inhibitor of angiogenesis. TSP1 is methylated in several malignancies, and can inhibit angiogenesis in melanoma xenografts.

Phosphatase inhibitor, sodium stibogluconate, in combination with interferon (IFN) alpha 2b: phase I trials to identify pharmacodynamic and clinical effects.

Since sodium stibogluconate (SSG) inhibited phosphatases including SHP-1 and augmented anti-tumor actions of IFN-α2b in vitro and in mice, two Phase I trials of SSG/IFN-α2b combination were undertaken to evaluate safety and target inhibition. Escalating doses of SSG (200-1200 mg/m2) and fixed doses of IFN-α2b (3x106 units/m2) with or without chemotherapy (dacarbazine, vinblastine, cisplatin) were evaluated for side effects and impact on SHP-1 phospho-substrates and IFNα-stimulated-genes (ISGs) in peripheral blood in 40 patients with metastatic melanoma, soft tissue sarcomas, gastrointestinal stromal tumors, and breast or colorectal carcinomas who did not have other established treatment options. Common adverse events were bone marrow suppression, fatigue, gastrointestinal upset, and asymptomatic lipase elevation (n=13); the latter was dose related and mostly after 10d of SSG/IFN-α2b in combination.

Gene regulatory and clinical effects of interferon β in patients with metastatic melanoma: a phase II trial.

Interferon (IFN)-β in preclinical studies, compared to IFN-α2, bound with higher affinity to its receptor, induced to higher levels of IFN-stimulated gene products, induced more apoptosis in melanoma cells, and had antitumor effects against melanoma. A maximally tolerated dose of 12 × 10(6) international units/m(2) after 2 weeks subcutaneously daily with dose escalation to 18 × 10(6) international units/m(2) was thus used in a phase II trial of IFN-β1a in cutaneous metastatic melanoma (n = 17) and uveal melanoma (n = 4). It resulted in expected but reversible drug-related severe (grade 3) adverse events in 13/21 patients; anorexia and fatigue were mostly of mild or moderate severity and infrequently needed dose reduction.

Reducing heart failure hospital readmissions from skilled nursing facilities.

Purpose/objectives: Readmission rates for heart failure patients are a Center for Medicare & Medicaid and Joint Commission core measure. At this urban Midwestern medical center, the 6-month baseline skilled nursing facility (SNF) readmission rate was 30%. Nurse case management implemented a process to decrease the rate for this population.

Nurse and physician preferences for end-of-life care for trauma patients.

Background: End-of-life care for trauma patients requires unique practice guidelines because it is fraught with difficulties not encountered in end-of-life care for terminally ill patients. The purpose of this project was to analyze survey information from nurses and physicians regarding preferences for end-of-life care in trauma that would inform best-practice guidelines.

Methods: A survey was sent via the US Postal Service to a convenience sample of trauma professionals, including physicians, nurses, and emergency medical technicians.

Surges of electroencephalogram activity at the time of death: a case series.

Abstract Level of consciousness at the end of life in critically ill patients is poorly characterized. We report a case series of seven patients who were neurologically intact before the decision to withdraw care due to extensive systemic critical illness. As part of our end-of-life care protocol, bispectral index (BIS) monitor (Aspect Medical Systems, Newton, MA) or SEDline (Hospira, Lake Forest, IL) monitoring devices are placed on each patient to ensure adequate comfort.

Proteasome inhibitors in the clinical setting: benefits and strategies to overcome multiple myeloma resistance to proteasome inhibitors.

The majority of intracellular proteins undergo degradation through the ubiquitin-proteasome pathway. The proteasome pathway has a role in regulating cell proliferation, differentiation, survival and apoptosis. The naturally occurring proteasome inhibitor lactacystin was the first proteasome inhibitor noted to induce apoptosis in vitro.

Short communication: phase I clinical and gene modulatory evaluation of tamoxifen and IFN-alpha2b.

Preclinical studies had determined that tamoxifen and interferon-alpha2b (IFN-alpha2b) synergistically inhibited growth of both estrogen-receptor positive and negative murine tumor xenografts and had combined antiangiogenic effects and that tamoxifen potentiated IFN-stimulated gene (ISG) expression. A phase I trial in 26 patients was conducted using the combination to define tolerance and potentiation of ISG expression. IFN- alpha2b at a dose of 3 x 10(6) units/m(2) daily was given subcutaneously (s.

A plan to improve end-of-life care for trauma victims and their families.

End-of-life care for trauma patients is unique in that clinicians rarely have the advantage of knowing victims prior to the event. In this setting, the unfamiliarity with patients' wishes and values, the critical nature of the injury, the overwhelming feelings of guilt that families often experience, the suddenness and acuity of the crisis, and the need to make life-and-death decisions, can result in end-of-life care scenarios that are challenging to manage and often difficult to experience. This article describes a plan to develop, implement, and test a best practice model of end-of-life care for trauma victims and their families.

Pump away high-risk infusion errors.

New intravenous pumps help increase safety measures and improve cost-effectiveness.

Medical futility in the natural attitude.

Medical futility has a long history going back to Plato but continues to be a controversial topic. Patients, families, and health professionals are faced with decisions about which treatments and interventions may be futile, but such questions as who decides; how do competing values get resolved; what value is placed on human life; how are decisions balanced according to reason and, in some circumstances, faith; and who decides effect, benefit, and burdens of treatments are often difficult to answer. The naïve reality of medical futility is explored in the natural attitude to expose presumptions and facts related to both physiologic (fact-based) and evaluative (value-based) futility components.

"Seeing" artificial hydration and nutrition through an ethical lens.

Nurses may be asked by conscious, rational patients to participate in the withdrawal of their life-sustaining nutritional support. The case study presented in this column gives clinicians a framework to handle these situations when they arise, using an ethical framework as their guide.

Proteomic identification of proteins conjugated to ISG15 in mouse and human cells.

Though the interferon-inducible protein ISG15 was one of the first ubiquitin-like modifiers to be discovered, much remains unknown about the identity of proteins conjugated to ISG15 or the biologic consequences of modification. To gain a better understanding of the cellular pathways affected by ISG15, we identified proteins targeted for ISGylation using a proteomic approach. Mass spectrometric analysis identified 76 candidate ISGylation targets in anti-ISG15 immunoprecipitates from interferon-treated mouse or human cells.

An emancipatory study of contemporary nursing practice.

Changes in health care facilities have created the necessity for individual nurses to change, eg, change jobs, pursue additional education, become independent entrepreneurs. There is a shortage of nurses that places stress on those who remain to care for an increasing number of persons with too few resources. The purposes of this study were to explore nurses' perceptions of the circumstances of their work lives and to describe the processes by which they can create change in these circumstances.