Objective:
This article revisits the responsible, accountable nurse with authority (RANA) model and its continued application to psychiatric-mental health nursing care nearly 30 years after its ...development. It will ascertain key elements of the model that remain in use today, while identifying parts of the model that have transformed over the years.
Methods:
This article will also explore the theoretical underpinnings of the model, including Peplau’s interpersonal relations theory. The impact of the primary nursing and relationship-based care models that influenced the RANA role will also be explored.
Results:
Specific examples of how the RANA model has affected unit outcomes will be identified, such as improved patient safety measures and satisfaction with care.
Conclusions:
The nurse–patient relationship and therapeutic alliance is fundamental to the RANA model and directly affects patient outcomes.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
This article reviews the nature and prevalence of nonsuicidal self-injury (NSSI) and suggests how it can be better recognized and treated in the mental health community. Throughout history, NSSI has ...been a core element of many types of rituals (e.g. cultural, religious, spiritual, and healing rituals) and is now also regarded as a pathological expression of emotional pain, particularly in Western cultures, where its occurrence has increased dramatically since the 1980s. NSSI involves the direct and deliberate self-infliction of bodily harm without suicidal intent. Self-injury can be viewed as a distinct mental health disorder, a defining criterion of other mental disorders, or a transient response to trauma or stress. Notwithstanding its etiology, NSSI should become a more salient aspect of psychiatric evaluation and intervention considering its frequency of occurrence and deleterious consequences, especially among young people. The current article consists of six sections that describe the terminology associated with NSSI; its general prevalence, measurement, and variability (age, race, and gender); its relationship with other psychiatric illness; and its diagnosis and treatment.
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BFBNIB, NUK, PILJ, SAZU, UL, UM, UPUK
Developmental changes occurring in the pediatric skeleton throughout childhood cause imaging appearances that may be confused with pathology. Knowledge of the typical pattern of red to yellow bone ...marrow conversion and areas of normal developmental irregular ossification is essential for radiologists interpreting musculoskeletal imaging in children to avoid mistaking normal findings for disease. Here we review the normal conversion of hematopoietic to yellow marrow on pediatric MRI and illustrate how MRI can distinguish the normal areas of irregular ossification from various pathology that can occur at and around growth centers in the developing skeleton.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background Medical student knowledge is assessed during surgical clerkships subjectively and objectively. Subjective evaluation depends on faculty assessment during clinical and didactic ...interactions. Objective measurement derives from standardized tools, such as the National Board of Medical Examiners Surgery Subject test (shelf). Few efforts have been made to characterize the correlation between subjective and objective measures of medical knowledge. Study Design All 308 third-year medical students who completed the 8-week surgery clerkship at the University of North Carolina at Chapel Hill between July 2005 and June 2007 received subjective assessment of knowledge on 3 clinical rotations (one 4-week core and two 2-week elective rotations) and a longitudinal small-group tutorial. Faculty evaluators assigned percentile scores to rate students' knowledge base relative to their peers. In addition, students took the shelf test the last day of clerkship, and percentile scores were assigned based on National Board of Medical Examiners−supplied normative data from first-time test-takers within the same academic quarter. Subjective versus objective knowledge scores were plotted overall, and Pearson product-moment correlation coefficients were generated for core, elective, and tutorial assessments. Results There were only weak linear relationships noted between subjective faculty-assigned knowledge scores and objective shelf scores. Pearson correlations were 0.24 for core rotations (4 weeks exposure), 0.14 for elective rotations (2 weeks exposure), and 0.22 for tutorials (1-hour exposure/week during 8 weeks), with p values <0.0001. Conclusions Faculty assessment of knowledge is only weakly correlated with shelf performance. Faculty evaluations after 4-week rotations or longitudinal small-group interactions are better correlated with shelf scores than after 2-week electives.
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GEOZS, NUK, OILJ, SBCE, SBJE, UL, UPUK
Objective Surgical resection has been the mainstay of curative treatment of early stage lung cancer in selected patients. We evaluated survival and patterns of recurrence after surgical resection for ...early stage lung cancer from the American College of Surgeons Oncology Group Z0030/Alliance trial. Methods One thousand eighteen patients enrolled in the Z0030 trial were analyzed according to clinical T stage. Differences between groups were compared using the 2-sample rank test or χ2 test. Log rank test and Cox proportional hazards regression were used to compare survival and recurrence. To compare patients who underwent open versus video-assisted thoracoscopic surgery (VATS) resections, propensity-score matched analysis was performed. Seven hundred fifty-two patients (66 undergoing VATS and 686 undergoing open surgery) were classified into 5 equal-sized propensity-score groups. Proportional hazards regression was used to compare these outcomes. Results There were 578 patients with cT1 tumors and 440 patients with cT2 tumors. Median follow-up was 6.7 years. Median overall survival was 9.1 years (stage T1) and 6.5 years (stage T2). Overall survival at 5 years was 72% (stage T1) and 55% (stage T2). Local recurrence-free survival at 5 years was 95% (stage T1) and 91% (stage T2) ( P = .015). Among patients with stage T1 cancer, 4.2% (23 out of 542) had local recurrences, whereas 7.3% (30 out of 409) of those with stage T2 tumors had local failure. There was no difference in the development of new primary tumors between stage T1 and stage T2 groups. In the propensity-score matched analysis of VATS versus open lobectomy patients, there was no difference in overall survival, disease-free survival, and freedom from development of a new primary tumor. Conclusions Results of patients with resected early stage non–small cell carcinoma from a large-scale, multicenter trial serve as benchmarks against which to compare nonsurgical therapies for early stage lung cancer. Propensity-score matched analysis shows no difference in survival between patients undergoing VATS and open lobectomy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Women diagnosed with late stage gynecological cancer encounter unique physical and psychosocial stressors compared to other cancer diagnoses, including poor survival rates. The existing body of ...literature focuses on identifying individual stressors or symptoms, studies one type of gynecological cancer, or quantifies symptom experiences. This interpretive phenomenological research study focused on the lived experiences of women diagnosed with stage II or greater gynecological cancer and it explored the individual's perspective related to quality of life, personal perceptions of cancer-related stigma, and the health-illness transition. Meleis' transitions theory and Roy's adaptation model provided the conceptual framework for this study. Ten women diagnosed with stage II or greater gynecological cancer, primarily from the Midwestern United States, were included in this study. Interpretive phenomenological approach and Saldana's (2013) processes of coding were used to guide data analysis from participant interviews. Five primary themes and 12 subthemes emerged from within the data describing The Existential Experience of Time, Awareness of Loss, Navigating New Waters, Sustaining Faith, and Moving Forward. This research promotes understanding of the personal perception and impact of the diagnosis of cancer, adaptation to the environmental stressor of cancer, and discovering meaning in the cancer experience and its impact on survivorship. This research highlighted the importance of communication by the health care provider throughout the patient's cancer journey, and clarified the critical importance and impact of the nurse's relationship with the patient during this process. Other implications for practice include improving knowledge of the physical and emotional changes these women experience throughout this process, in addition to recognizing the losses the women encounter and the modes of adaptation they utilize. Within this study, women diagnosed with late stage gynecological cancer provided rich, thick descriptions of the lived experience of an advanced gynecological cancer diagnosis. The unique physical and psychosocial symptoms these women experience are intertwined and influence patients' perception of time and quality of life. Findings illuminated the significance of the health-illness transition and the concepts of adaptation and stigmatization that occur in women with advanced stage gynecological cancer and this study can provide the framework for future research in these areas.
Abstract Diseases of the cardiac conduction system can be debilitating and deadly. Electronic pacemakers are incredibly effective in the treatment of sinus and AV node dysfunction, yet there remain ...important limitations and complications. These issues have driven interest in the development of a biological pacemaker. Here, we review experimental progress in animal models and discuss future directions, with a focus on reprogramming endogenous cells in the heart to treat defects of rhythm and conduction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Educational evolution is particularly important in pathology, particularly cytopathology, due to the vast amounts of independent learning required to master this field. In this study, ...learning challenges faced by pathology residents were addressed through a variety of educational modalities including 24 short (∼10 minute) online tutorials (dubbed “Sound Bites”) covering selected topics in cytopathology as well as other areas of anatomic and clinical pathology. Additionally, residents were provided with an annotated glass slide set covering pediatric pathology with an associated multiple choice self-assessment as well as multiheaded microscope slide review sessions. Use of these modalities was tracked and residents surveyed about their experiences using them. All 20 residents (100%) reported using Sound Bites either from work computers, home computers, or mobile devices. Residents reported that easy accessibility, brevity, and opportunities for self-assessment were important variables contributing to this use, and that Sound Bite use would make them more likely to benefit from in-person teaching through lectures and/or slide sessions. Within 12 months of the release of the first Sound Bite, individual Sound Bites were accessed a total of 1169 times (mean: 49 times per Sound Bite). In contrast, slide sets were only accessed about once a month and were only employed by 30% of residents (6 of 20) for independent study; only 20% (4 of 20) completed the accompanying multiple choice self-assessment. All residents attended multiheaded microscope slide review sessions. Whereas traditional educational methods remain valuable tools in pathology education, these data suggest that short, web-based tutorials represent a valuable adjuvant teaching tool.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
RNA interference (RNAi) is conserved in eukaryotic organisms, and it has been well studied in many animal and plant species and some fungal species, yet it is not well studied in fungal plant ...pathogens. In the rice blast fungus Magnaporthe oryzae, we examined small RNA (sRNA) and their biogenesis in the context of growth and pathogenicity. Through genetic and genomic analyses, we demonstrate that loss of a single gene encoding Dicer, RNA-dependent RNA polymerase, or Argonaute reduces sRNA levels. These three proteins are required for the biogenesis of sRNA-matching genome-wide regions (coding regions, repeats, and intergenic regions). The loss of one Argonaute reduced both sRNA and fungal virulence on barley leaves. Transcriptome analysis of multiple mutants revealed that sRNA play an important role in transcriptional regulation of repeats and intergenic regions in M. oryzae. Together, these data support that M. oryzae sRNA regulate developmental processes including, fungal growth and virulence.
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