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Exploring Nurses’ Documentation Prioritization in the Context of Documentation Burden: A Mixed Methods Approach.
No full textObjective: This study aimed to understand how inpatient nurses determine and prioritize patient care documentation within the context of the Electronic Health Records (EHRs) burden.
Methodology: We employed a Nested Concurrent Mixed Methods (NCMM) design, predominantly using qualitative interviews supplemented by quantitative web-based surveys. Both approaches were conducted simultaneously but analyzed independently. The findings were merged using a narrative weave approach during the data triangulation. A phenomenological approach explored the lived experiences of inpatient nurses\u27 EHR documentation prioritization. The qualitative component used an interpretive phenomenology design, while the quantitative component utilized a cross-sectional survey design to measure nurses\u27 perceptions of the EHR documentation burden. Registered nurses (RNs) from acute and critical care settings were recruited via purposive and snowball sampling. Qualitative data were collected through semi-structured interviews and analyzed using Colaizzi’s 7-step thematic analysis and Smith’s Interpretive Phenomenology Analysis (IPA). The quantitative data collection used Qualtrics to distribute a 27-item questionnaire, analyzed with descriptive statistics and content analysis for open-ended questions.
Results: Fourteen RNs participated in the qualitative study, revealing five key themes: (1) Professional judgment in documentation, (2) Real-time versus delayed documentation, (3) EHR-driven documentation impacting nurse autonomy, (4) Unnecessary and redundant documentation, and (5) Emotional strain from defensive charting. Nurses prioritized patient care over EHR documentation, frequently encountering tasks that did not contribute to patient care. Of the 133 RNs surveyed, 80% (n=103) reported that EHR documentation requirements fail to reflect the true quality of care and identified some documentation as unnecessary. Flowsheets, notes, and patient education were the most burdensome tasks. Nurses supported by leadership valued their documentation more (r=0.44). Open-ended responses indicated concerns about repetitive documentation, care plans, daily cares and safety, time spent, and navigating flowsheets. Recommendations included automating data entry, eliminating redundancy, and simplifying care plans.
Discussion: Healthcare organizations must empower nurses by reducing non-value-added documentation and allowing them to exercise clinical judgment. Streamlined documentation processes can reduce emotional stress and promote patient-centered care. Survey findings underscored the need to reduce unnecessary tasks and leverage EHR functionality for meaningful documentation.
Conclusion: Understanding how nurses prioritize documentation provides valuable insights into reducing EHR burden and enhancing patient care quality and organizational efficiency
Virologic effects of broadly neutralizing antibodies VRC01LS and VRC07-523LS on chronic HIV-1 infection
No full textBACKGROUNDHIV-1-specific broadly neutralizing monoclonal antibodies (bNAbs) have emerged as promising interventions with the potential to effectively treat and prevent HIV-1 infections. We conducted a phase I clinical trial evaluating the potent CD4-binding site-specific (CD4bs-specific) bNAbs VRC01LS and VRC07-523LS in people with HIV-1 (PWH) not receiving antiretroviral therapy (ART).METHODSParticipants received a single intravenous 40 mg/kg dose of either VRC01LS (n = 7) or VRC07-523LS (n = 9) and did not initiate ART for a minimum of 14 days. The primary study objective was to evaluate safety and tolerability; the secondary study objectives were to evaluate pharmacokinetics (PK) and the impact of administered bNAbs on viral loads (VL) and CD4+ T cell counts in the absence of ART.RESULTSThis trial enrolled 16 PWH aged 20 to 57 years. Both bNAbs were safe and well tolerated. Mild local reactogenicity was only reported in participants who received VRC07-523LS, while both bNAbs were associated with mild systemic symptoms. Maximum serum concentrations (Cmax) following VRC01LS or VRC07-523LS were 1,566 ± 316 and 1,295 ± 376 μg/mL, respectively. VRC07-523LS administration significantly decreased VL in 8 out of 9 participants, with an average decline of 1.7 ± 0.8 log10 copies/mL within 14 days after administration. In contrast, VRC01LS administration resulted in a smaller average decline (0.8 ± 0.8 log10 copies/mL), and 3 out of 7 participants showedno change in VL. Postinfusion maximum decline in VL correlated with post hoc baseline in vitro viral susceptibility results for both bNAbs.CONCLUSIONThe results of this trial support inclusion of potent CD4bs-specific bNAbs, such as VRC07-523LS, into next-generation treatment regimens for HIV-1.TRIAL REGISTRATIONClinicalTrials.gov NCT02840474.FUNDINGNational Institute of Allergy and Infectious Diseases (NIAID)/NIH (grants UM1 AI068634, UM1 AI068636, UM1 AI106701, UM1AI069424, UM1AI069501, UM1AI69415, UM1AI069534, UM1AI69494); the Intramural Research Program of the NIAID/NIH; National Center for Advancing Translational Sciences/NIH (grants UM1TR004548, UL1TR001881, and UL1TR001878); and the National Cancer Institute/NIH (contract 75N91019D00024)
White matter connections within the central sulcus subserving the somato-cognitive action network
No full textThe somato-cognitive action network (SCAN) consists of three nodes interspersed within Penfield\u27s motor effector regions. The configuration of the somato-cognitive action network nodes resembles the one of the \u27plis de passage\u27 of the central sulcus: small gyri bridging the precentral and postcentral gyri. Thus, we hypothesize that these may provide a structural substrate of the somato-cognitive action network. Using microdissections of 16 human hemispheres, we consistently identified a chain of three distinct plis de passage with increased underlying white matter in locations analogous to the somato-cognitive action network nodes. We mapped localizations of plis de passage into standard stereotactic space to seed functional MRI connectivity across 9000 resting-state functional MRI scans, which demonstrated the connectivity of these sites with the somato-cognitive action network. Intraoperative recordings during direct electrical central sulcus stimulation further identified inter-effector regions corresponding to plis de passage locations. This work provides a critical step towards an improved understanding of the somato-cognitive action network in both structural and functional terms. Furthermore, our work has the potential to guide the development of refined motor cortex stimulation techniques for treating brain disorders and operative resective techniques for complex surgery of the motor cortex
Autophagy is required for the therapeutic effects of the NAD+ precursor nicotinamide in obesity-related heart failure with preserved ejection fraction
No full textBi-allelic LAMP3 variants in childhood interstitial lung disease: A surfactant-related disease
No full textBACKGROUND: LAMP3 encodes a lysosomal membrane protein associated with lamellar bodies and has recently been proposed as a candidate gene for childhood interstitial lung diseases (chILD). Here, we identified two LAMP3 variants in a proband with chILD and performed functional validation of these variants as well as the previously reported variants to demonstrate the role of LAMP3 in pathology.
METHODS: LAMP3 variants were identified by exome sequencing. Ex vivo studies included mRNA analysis from nasal brushing and lung tissue and immunohistochemistry from lung biopsy. In vitro functional analyses in the A549 cell line included immunofluorescence staining and expression analysis of LAMP3. Interactions between LAMP3 and the surfactant protein (SP)-B and SP-C were evaluated by co-immunoprecipitation.
FINDINGS: Two heterozygous LAMP3 variants (Y302Qfs∗2 and T268M) were identified in a 15 year old boy with chILD. LAMP3 mRNA revealed that the frameshift variant resulted in nonsense-mediated mRNA decay. Reduced LAMP3 expression was confirmed in the patient\u27s lung tissue. Functional studies of the T268M and the previously reported G288R variant revealed reduced levels of the mutant proteins. In addition, impaired N-glycosylation and protein instability were demonstrated with the T268M variant. Finally, we provided evidence for an interaction between LAMP3 and SP-B and SP-C, revealing a direct link between LAMP3 and surfactant metabolism.
INTERPRETATION: LAMP3 bi-allelic variants leading to LAMP3 dysfunction emerges as a cause of chILD associated with a heterogeneous phenotype that remains to be further defined. The close links between LAMP3 and surfactant metabolism could explain the pathophysiology of this genetic disease.
FUNDING: No specific funding
Factors influencing cyanoacrylate tissue adhesive outcomes for corneal thinning and perforation
No full textDominant interfering CARD11 variants disrupt JNK signaling to promote GATA3 expression in T cells
No full textSeveral primary atopic disorders are linked to monogenic defects that attenuate TCR signaling, favoring T helper type 2 (TH2) cell differentiation. Patients with CARD11-associated atopy with dominant interference of NF-κB signaling (CADINS) disease suffer from severe atopy, caused by germline loss-of-function/dominant interfering (LOF/DI) CARD11 variants. The CARD11 scaffold enables TCR-induced activation of NF-κB, mTORC1, and JNK signaling, yet the function of CARD11-dependent JNK signaling in T cells remains nebulous. Here we show that CARD11 is critical for TCR-induced activation of JNK1 and JNK2, as well as canonical JUN/FOS AP-1 family members. Patient-derived CARD11 DI variants attenuated WT CARD11 JNK signaling, mirroring effects on NF-κB. Transcriptome profiling revealed JNK inhibition upregulated TCR-induced expression of GATA3 and NFATC1, key transcription factors for TH2 cell development. Further, impaired CARD11-JNK signaling was linked to enhanced GATA3 expression in CADINS patient T cells. Our findings reveal a novel intrinsic mechanism connecting impaired CARD11-dependent JNK signaling to enhanced GATA3/NFAT2 induction and TH2 cell differentiation in CADINS patients
Synergies, partnership outcomes, and lessons learned: A qualitative evaluation of cancer center-coalition engagement
No full textBACKGROUND: Nine National Cancer Institute-Designated Cancer Centers received supplemental funding to expand community outreach and engagement activities through a partnership with Centers for Disease Control and Prevention-funded comprehensive cancer control coalitions. This article reports on an evaluation of these awards focused on organizational relationships and partnership outcomes.
METHODS: The National Cancer Institute, community outreach and engagement, and coalition representatives co-designed the evaluation, which involved document review and 18 semistructured interviews with 16 community outreach and engagement and 19 coalition representatives. Artificial intelligence-generated interview transcripts were dual-coded in NVivo, version 20/R1, software.
RESULTS: The funding generated a diverse collection of projects and partnerships. Community outreach and engagement-coalition synergies and lessons learned were evident in the following domains: infrastructure; community and partner engagement; data monitoring; and intervention implementation, evaluation, and dissemination. Outcomes of this funding initiative were evident in the following domains: strengthened partnerships, expanded knowledge, improved health or health-care programs and policies, and thriving communities.
CONCLUSIONS: Fostering community outreach and engagement-coalition partnerships created opportunities to use synergies and build capacity for engagement across multiple domains, contributing to enhanced trust and implementation of interventions across the cancer continuum. The findings provide examples and lessons on which cancer centers and coalitions can capitalize. Successful collaborative relationships were based on identifying shared goals and complementary expertise and roles, sharing financial and other resources, and a commitment to authentic and open dialogue. Although modest and short term, supplemental funding can strengthen organizational relationships and promote effective collaboration on community-facing activities; it can also lead to improved research engagement and translation of evidence to practice
Age-related mesenchymal stromal cell senescence is associated with progression from MGUS to multiple myeloma
No full textThe risk of progression of monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM) increases with advancing age, suggesting that progression may be influenced by age-related changes within the bone marrow (BM) microenvironment. We hypothesise that senescent mesenchymal stromal cells (MSCs), which accumulate in the BM with age, may contribute to MGUS progression to MM. Here, we show that, like BM MSCs from aged non-cancer controls, BM MSCs from both MM and MGUS patients exhibit a senescent phenotype characterised by enlarged, flattened morphology, increased β-galactosidase activity and CDKN2A expression, and decreased proliferation rate compared with BM MSCs from healthy young individuals. While coculture with BM MSCs suppresses the proliferative capacity of MM cell lines in vitro, induction of senescence via irradiation or replicative exhaustion in healthy MSCs relieves this suppression, compared with non-senescent MSCs. This may, in part, be attributable to upregulated expression of the BMP antagonist Gremlin1 in senescent MSCs, which facillitates MM cell proliferation. Notably, the risk of progression to MM was significantly elevated in MGUS patients with increased MSC senescence. Collectively, our data provide evidence that age-related accumulation of senescent MSCs may be a driver of MGUS to MM progression
Self-other generalisation shapes social interaction and is disrupted in borderline personality disorder
Full text linkGeneralising information from ourselves to others, and others to ourselves allows for both a dependable source of navigation and adaptability in interpersonal exchange. Disturbances to social development in sensitive periods can cause enduring and distressing damage to lasting healthy relationships. However, identifying the mechanisms of healthy exchange has been difficult. We introduce a theory of self-other generalisation tested with data from a three-phase social value orientation task - the Intentions Game. We involved humans with