Practice Patterns Contributing to Positive Patient Outcomes by Nurse Practitioners

Purpose: The purpose of this study was to identify NP practice patterns most important for positive patient outcomes. Data Sources: A convenience sample (n = 93) of Nurse Practitioners attending the 2005 California Association for Nurse Practitioners Conference (N = 535) completed the survey. Conclusions: The most important practice patterns identified were associated with patient-centered care. When analyzed with years in practice, patient-centered practice patterns continued to be the most important. This study suggests that patient-centered practice patterns are most important to positive patient outcomes for NPs. Implications for practice: Identifying the practice patterns that are most important to positive patient outcomes creates a distinct picture of the quality of care that is unique to nursing. As the role of NP continues to expand and be defined, these practice patterns will provide evidence of the unique quality of care given by the NP profession

Standardisation of partial strength connections of extended end-plate connections for trapezoid web profiled steel sections

Traditionally, connections are usually classified as pinned or rigid although the actual behaviour is known to fall between these two extreme cases. The use of partial strength or semi-rigid connections has been encouraged by codes and studies on the matter known as semi-continuous construction have proven that substantial savings in steel weight of the overall construction. The objective of this paper is to develop a series of standardised partial strength connections tables of extended end-plate connections for trapezoidal web profiled steel (TWP) sections. The range of standard connections presented in tabulated form is limited to eight tables comprised of different geometrical aspects of the connections. These tables could enhance the design of semi-continuous construction of multi-storey braced steel frames. The connections are presented in the form of standardised tables which include moment capacity and shear capacity after considering all possible failure modes. A method proposed by Steel Construction Institute (SCI) which take into account the requirements in Eurocode 3 and BS 5950:2000 Part 1 were adopted to predict the moment capacity and shear capacity in developing the tables. A series of tests have been carried out to validate the results of the standardised tables. The test results showed good agreement between theoretical and experimental values. It can be concluded that the proposed standardised tables for TWP sections is suitable to be used in the design of semi-continuous construction

Renal function and physical fitness after 12-mo supervised training in kidney transplant recipients

To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations

Transfusion of red blood cells: the impact on short-term and long-term survival after coronary artery bypass grafting, a ten-year follow-up.

Transfusion of red blood cells (RBC) and other blood products in patients undergoing coronary artery bypass grafting (CABG) is associated with increased mortality and morbidity. We retrospectively analyzed data of patients who underwent an isolated coronary bypass graft operation between January 1998 and December 2007. Mean follow-up was 1696±1026 days, with exclusion of 122 patients lost to follow-up and 80 patients who received 10 units of RBC. Of the remaining patients, 8001 (76.7%) received no RBC, 1621 (15.2%) received 1–2 units of RBC, 593 (5.7%) received 3–5 units and 220 (2.1%) received 6–10 units. The number of transfused RBC was a predictor for early but not for late mortality. When compared to expected survival, survival of patients not receiving any blood product was better, while survival of patients receiving >3 units of RBC was worse. Transfusion of RBC is an independent, dose-dependent risk factor for early mortality after revascularization. Compared to expected survival, receiving no RBC improves patient long-term survival, whereas receiving three or more units of RBC significantly decreases patient survival

World Cup Watching

This essay describes Jack\u27s experience dealing with World Cup fever in Bath, England, during the 2010 World Cup. It\u27s Jack\u27s outsider\u27s perspective on the impact of world cup competition while he taught in the Advanced Studies in England Program

Impact of cyclooxygenase inhibitors in the Women's Health Initiative hormone trials: secondary analysis of a randomized trial.

OBJECTIVES: We evaluated the hypothesis that cyclooxygenase (COX) inhibitor use might have counteracted a beneficial effect of postmenopausal hormone therapy, and account for the absence of cardioprotection in the Women's Health Initiative hormone trials. Estrogen increases COX expression, and inhibitors of COX such as nonsteroidal anti-inflammatory agents appear to increase coronary risk, raising the possibility of a clinically important interaction in the trials. DESIGN: The hormone trials were randomized, double-blind, and placebo-controlled. Use of nonsteroidal anti-inflammatory drugs was assessed at baseline and at years 1, 3, and 6. SETTING: The Women's Health Initiative hormone trials were conducted at 40 clinical sites in the United States. PARTICIPANTS: The trials enrolled 27,347 postmenopausal women, aged 50-79 y. INTERVENTIONS: We randomized 16,608 women with intact uterus to conjugated estrogens 0.625 mg with medroxyprogesterone acetate 2.5 mg daily or to placebo, and 10,739 women with prior hysterectomy to conjugated estrogens 0.625 mg daily or placebo. OUTCOME MEASURES: Myocardial infarction, coronary death, and coronary revascularization were ascertained during 5.6 y of follow-up in the estrogen plus progestin trial and 6.8 y of follow-up in the estrogen alone trial. RESULTS: Hazard ratios with 95% confidence intervals were calculated from Cox proportional hazard models stratified by COX inhibitor use. The hazard ratio for myocardial infarction/coronary death with estrogen plus progestin was 1.13 (95% confidence interval 0.68-1.89) among non-users of COX inhibitors, and 1.35 (95% confidence interval 0.86-2.10) among continuous users. The hazard ratio with estrogen alone was 0.92 (95% confidence interval 0.57-1.48) among non-users of COX inhibitors, and 1.08 (95% confidence interval 0.69-1.70) among continuous users. In a second analytic approach, hazard ratios were calculated from Cox models that included hormone trial assignment as well as a time-dependent covariate for medication use, and an interaction term. No significant interaction was identified. CONCLUSIONS: Use of COX inhibitors did not significantly affect the Women's Health Initiative hormone trial results

Lower cerebrospinal fluid/plasma fibroblast growth factor 21 (FGF21) ratios and placental FGF21 production in gestational diabetes

Objectives: Circulating Fibroblast Growth Factor 21 (FGF21) levels are increased in insulin resistant states such as obesity, type 2 diabetes mellitus and gestational diabetes mellitus (GDM). In addition, GDM is associated with serious maternal and fetal complications. We sought to study human cerebrospinal fluid (CSF) and corresponding circulating FGF21 levels in women with gestational diabetes mellitus (GDM) and in age and BMI matched control subjects. We also assessed FGF21 secretion from GDM and control human placental explants. Design: CSF and corresponding plasma FGF21 levels of 24 women were measured by ELISA [12 GDM (age: 26–47 years, BMI: 24.3–36.3 kg/m2) and 12 controls (age: 22–40 years, BMI: 30.1–37.0 kg/m2)]. FGF21 levels in conditioned media were secretion from GDM and control human placental explants were also measured by ELISA. Results: Glucose, HOMA-IR and circulating NEFA levels were significantly higher in women with GDM compared to control subjects. Plasma FGF21 levels were significantly higher in women with GDM compared to control subjects [234.3 (150.2–352.7) vs. 115.5 (60.5–188.7) pg/ml; P<0.05]. However, there was no significant difference in CSF FGF21 levels in women with GDM compared to control subjects. Interestingly, CSF/Plasma FGF21 ratio was significantly lower in women with GDM compared to control subjects [0.4 (0.3–0.6) vs. 0.8 (0.5–1.6); P<0.05]. FGF21 secretion into conditioned media was significantly lower in human placental explants from women with GDM compared to control subjects (P<0.05). Conclusions: The central actions of FGF21 in GDM subjects maybe pivotal in the pathogenesis of insulin resistance in GDM subjects. The significance of FGF21 produced by the placenta remains uncharted and maybe crucial in our understanding of the patho-physiology of GDM and its associated maternal and fetal complications. Future research should seek to elucidate these points

Review. William D. Davies &amp; Stanley Dubinsky (eds.), New horizons in the analysis of control and raising (Studies in Natural Language &amp; Linguistic Theory 71). Dordrecht: Springer, 2007. Pp. x+347.

This article is a review of William D. Davies &amp; Stanley Dubinsky's "New horizons in the analysis of control and raising" (Studies in Natural Language &amp; Linguistic Theory 71)