A Compelling Case for Evidence-Based Practice Mentor Development Programs: An Integrative Review

Background: In 2008, The Institute of Medicine (IOM) set a goal that by 2020, 90% of healthcare decisions would originate from the best evidence available. This goal remains intangible for many organizations. Despite reporting quality and safety as a top organizational priority, a survey of 276 Chief Nurse Executives (CNEs) found that only roughly 50% of the CNEs said that EBP was practiced in their hospitals only “somewhat” or “not at all” (Melnyk, Gallagher‐Ford, Thomas, Troseth, Wyngarden, Kzalacha, 2016). Many organizations struggle to systematically integrate EBP into practice (Melnyk et al., 2018; Warren et al., 2016a). The Advancing Research and Clinical Practice Through Close Collaboration (ARCC) Model presents a framework to promote the systematic integration of EBP using EBP mentors (Melnyk, 2017). Aim: To evaluate the research findings related to EBP mentor development programs, to identify effective practices, and to assess the outcomes associated with EBP mentor programs. Methods: A comprehensive review of the literature was conducted to retrieve studies from CINHAL, PubMed, and Scopus, using keywords and subject headers related to EBP mentorship and quality and safety outcomes. Studies were appraised and reviewed to compare mentor program composition and examine clinician, organizational, and patient outcomes. Findings: Fifteen studies met inclusion criteria: one randomized control trial (RCT), one literature review, eleven descriptive studies, and two case reviews. Most programs included didactic content, an EBP project with coaching, and resources to support learning. The studies found that these programs led to improvements in clinicians’ EBP beliefs, practices, and abilities, and the organization’s readiness for EBP, and improving patient safety. Implications to Practice: There is solid justification for healthcare organizations to invest in an EBP mentor development progra

Development and Implementation of an Evidence-Based Practice Mentor Fellowship

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017). Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation. Context: The EBP Mentor Fellowship program was closely aligned with the organization\u27s mission, vision, and nursing strategic plan and was supported by leadership. Interventions: The fellowship was designed to develop knowledge and skills in a team of EBP mentors. Following a week-long EBP workshop, fellows participated in coaching sessions, worked in teams to complete an EBP project, and accessed an online repository of EBP resources. Outcomes Measures: The variables measured were EBP competence, EBP beliefs, EBP implementation, and organizational readiness for EBP. Results: Comparison of pre- and post-intervention survey results indicated higher EBP competency, stronger beliefs about the value of EBP, and greater frequency of EBP implementation. Conclusions: The organization gained eight EBP Mentors who can assist clinical nurses and nurse leaders. Future spread of the project is anticipated based on the gains observed in the pilot and the close alignment with the nursing strategic plan

Vocal foragers and silent crowds : context-dependent vocal variation in Northeast Atlantic long-finned pilot whales

This study was financially supported by the US Office of Naval Research, The Netherlands Ministry of Defence, the Norwegian Research Council and the Norwegian Ministry of Defence.Vocalisations form a key component of the social interactions and foraging behaviour of toothed whales. We investigated changes in calling and echolocation behaviour of long-finned pilot whales between foraging and non-foraging periods, by combining acoustic recordings and diving depth data from tagged individuals with concurrent surface observations on social behaviour of their group. The pilot whales showed marked vocal variation, specific to foraging and social context. During periods of foraging, pilot whales showed more vocal activity than during non-foraging periods (rest, travel). In addition to the expected increase in echolocation activity, call rates also increased, suggesting that pilot whales communicate more during foraging. Furthermore, calls with multiple inflections occurred more often immediately before and after foraging dives and during the early descent and late ascent phases of foraging dives. However, these calls were almost never detected at diving depths of the tagged whale beyond 350 m. Calls with no or few inflections were produced at all times, irrespective of diving depth of the tagged whale. We discuss possible explanations for the distinct vocal variation associated with foraging periods. In addition, during non-foraging periods, the pilot whales were found to be more silent (no calling or echolocation) in larger, more closely spaced groups. This indicates that increased levels of social cohesion may release the need to stay in touch acoustically. Significance statement: Social toothed whales rely on vocalisations to find prey and interact with conspecifics. Species are often highly vocal and can have elaborate call repertoires. However, it often remains unclear how their repertoire use correlates to specific social and behavioural contexts, which is vital to understand toothed whale foraging strategies and sociality. Combining on-animal tag recordings of diving and acoustic behaviour with observations of social behaviour, we found that pilot whales produce more calls during foraging than during non-foraging periods. Moreover, highly inflected calls were closely associated to the periods around and during foraging dives. This indicates enhanced communication during foraging, which may, for example, enable relocation of conspecifics or sharing of information. Whales reduced their vocal activity (calling and echolocation) at increased levels of social cohesion, indicating that in certain behavioural contexts, closer association (i.e. more closely spaced) may release the need to stay in touch acoustically.Publisher PDFPeer reviewe

Preparation of functionalized poly(caprolactone diol)/castor oils blends to be applied as photocrosslinkable tissue adhesives

Polycaprolactone (PCL) and PCL-based materials are widely applied in the biomedical field, however, their slow biodegradation profile makes them more suitable to be used in hard tissues, where healing requires longer periods of time. In order to adjust their properties to suit for soft tissues applications, PCL can be blended with other biodegradable materials in order to tune its degradation rate. Herein, polymeric blends of PCL and castor oil (CO) were prepared after their chemical modification with 2-isocyanatoethylmethacrylate (IEMA) in order to be applied as photocrosslinkable tissue adhesives. These functionalized macromers were chemically characterized and used to prepare polymeric blends (PCL-IEMA/CO-IEMA) with variable mass proportions. A biocompatible photoinitiator (Irgacure 2959) was added to these macromers blends which were then irradiated under UV light. The feasibility of the prepared materials as tissue adhesives was evaluated by assessment of their chemical/physical properties as well as their interaction with blood. Moreover, their cytotoxic profile was also evaluated through in vitro studies using human dermal fibroblasts as model cells.info:eu-repo/semantics/acceptedVersio

Wfs1E864K knock-in mice illuminate the fundamental role of Wfs1 in endocochlear potential production.

peer reviewedWolfram syndrome (WS) is a rare neurodegenerative disorder encompassing diabetes mellitus, diabetes insipidus, optic atrophy, hearing loss (HL) as well as neurological disorders. None of the animal models of the pathology are presenting with an early onset HL, impeding the understanding of the role of Wolframin (WFS1), the protein responsible for WS, in the auditory pathway. We generated a knock-in mouse, the Wfs1E864K line, presenting a human mutation leading to severe deafness in affected individuals. The homozygous mice showed a profound post-natal HL and vestibular syndrome, a collapse of the endocochlear potential (EP) and a devastating alteration of the stria vascularis and neurosensory epithelium. The mutant protein prevented the localization to the cell surface of the Na+/K+ATPase β1 subunit, a key protein for the maintenance of the EP. Overall, our data support a key role of WFS1 in the maintenance of the EP and the stria vascularis, via its binding partner, the Na+/K+ATPase β1 subunit

Motor imagery evokes increased somatosensory activity in parkinson's disease patients with tremor

Item does not contain fulltextParkinson's disease (PD) is surprisingly heterogeneous: some patients have a prominent resting tremor, while others never develop this symptom. Here we investigate whether the functional organization of the voluntary motor system differs between PD patients with and without resting tremor, and whether these differences relate to the cerebral circuit producing tremor. We compared 18 PD patients with marked tremor, 20 PD patients without tremor, and 19 healthy controls. Subjects performed a controlled motor imagery task during fMRI scanning. We quantified imagery-related cerebral activity by contrasting imagery of biomechanically difficult and easy movements. Tremor-related activity was identified by relating cerebral activity to fluctuations in tremor amplitude, using electromyography during scanning. PD patients with tremor had better behavioral performance than PD patients without tremor. Furthermore, tremulous PD patients showed increased imagery-related activity in somatosensory area 3a, as compared with both healthy controls and to nontremor PD patients. This effect was independent from tremor-related activity, which was localized to the motor cortex, cerebellum, and thalamic ventral intermediate nucleus (VIM). The VIM, with known projections to area 3a, was unique in showing both tremor- and imagery-related responses. We conclude that parkinsonian tremor influences motor imagery by modulating central somatosensory processing through the VIM. This mechanism may explain clinical differences between PD patients with and without tremor