Adapting Civility Education in an Academic-Practice Partnership

BACKGROUND

Incivility results in nurse burnout, decreased job performance, and decreased patient safety. Leaders of an academic-practice partnership developed educational activities promoting organizational civility during the COVID-19 pandemic. The purpose of this article is to describe an educational activity about civility that was transitioned to a virtual platform and participants' comfort engaging in and responding to incivility.

METHOD

Face-to-face education was converted to a synchronous online event, supporting 75 nurses, nursing students, and other health care professionals in attendance. Activities consisted of cognitive rehearsal techniques, breakout rooms, simulation videos, group debriefs, and panel discussions delivered via Zoom and Mentimeter software.

RESULTS

Workplace Civility Index results were significantly different from pretest to post-test. Seventy-two percent of participants were not comfortable gossiping about others, but only 30% were comfortable responding to incivility.

CONCLUSION

Promoting civility awareness through a virtual education platform using cognitive rehearsal techniques and reflection can provide support for current and future nurses. [J Contin Educ Nurs. 2021;52(12):575-580.].

Credentialing and certification: Overview, science, and impact on policy, regulation, and practice

AIM

To engage the global nursing community in sharing knowledge, experiences, and lessons learned about credentialing of individual nurses to improve nursing practice, patient safety, and quality of care.

BACKGROUND

Although the United States has a long and robust history of credentialing individual nurses, the opportunity exists to expand the dialogue globally, and is supported by globally focused governing bodies who call for increased or expanded investment in nursing certification and credentialing. Foundational work to define and operationalize certification for research purposes and develop an administrative home for stakeholders interested in certification can be leveraged by countries and regions globally. Existing frameworks for credentialing research may be used to drive theory-based research in the future.

SOURCES OF EVIDENCE

PubMed, International Council of Nurses, National Academies of Sciences, Engineering, and Medicine, World Health Organization, American Nurses Association, American Nurses Credentialing Center, and the authors' own experiences.

DISCUSSION

Credentialing as a form of self-governance, as a method for public protection, and as a foundational element in the increasingly new forms of healthcare delivery is intensifying in importance. Credentials provide an opportunity to evaluate relationships between key elements such as nursing practice, environments where nursing care is delivered, and nursing programs with outcomes of interest for the profession such as safety, quality of care, and patient outcomes.

CONCLUSIONS

Establishing rigorous credentials for nurses demonstrates a commitment to excellence. Credentialing frameworks that are universally applied could enable nurses to move seamlessly across geographic boundaries, permit regulators and employers of nurses to have a common set of standards and expectations, and ensure a level of competency for nursing practice that can be interpreted and trusted by various stakeholders.

IMPLICATIONS FOR NURSING POLICY

Policymakers have a pivotal role in advancing credentialing in nursing worldwide. Countries developing credentialing programs in nursing need to study their results to help inform how practice might be required to change over time.

Communicating Expectations: Developing a Rubric for Peer Reviewers

The peer-review process is a form of self-regulation by qualified members of the profession to evaluate works done by one or more individuals. However, without a clear structure, the peer-review process can be problematic. Rubrics have been shown to increase peer reviewer satisfaction and author compliance, but only when they convey clear and specific descriptions for task-specific criteria. Sigma developed a peer-review rubric to provide consistency in judging scientific abstracts. An asynchronous provider-directed, provider-paced educational activity can be used to successfully educate peer reviewers on the benefit and use of a peer-review rubric. [J Contin Educ Nurs. 2021;52(2):64-66.].

Innovative Opportunities for Civility: Professional Development in a Time of COVID-19

The impact of the COVID-19 pandemic on nursing professional development has spurred innovative teaching efforts by educators. The application of new technology provided innovative support for participant engagement and allowed for evaluation of civility education learning outcomes. A technology expert provided necessary support in a live virtual environment. A planned dress rehearsal prior to the live event ensured the functionality of the virtual platform. The versatility of the new technology allowed breakout rooms and interactive software applications. Nursing professional development practitioners can use these tips to reimagine other face-to-face educational activities into a virtual platform. [J Contin Educ Nurs. 2021;52(1):11-12.].

Patients affected by a new variant of endemic pemphigus foliaceus have autoantibodies colocalizing with MYZAP, p0071, desmoplakins 1-2 and ARVCF, causing renal damage

BACKGROUND

We have previously reported that about 30% of patients affected by a new variant of endemic pemphigus foliaceus (EPF) in El Bagre, Colombia (termed El Bagre-EPF or pemphigus Abreu-Manu) have systemic compromise. In the current study, we focused on studying autoreactivity to the kidney and its pathological correlations.

AIM

To investigate patients with El Bagre-EPF for renal compromise.

METHODS

We performed a case-control study, enrolling 57 patients with El Bagre-EPF and 57 controls from the endemic area, matched by age, sex, race, work activity, demographics and comorbidities. We took skin and renal biopsies; performed direct and indirect immunofluorescence, immunohistochemistry (IHC), confocal microscopy, immunoblotting, direct and indirect immune electron microscopy; and tested kidney function in all living patients. We also used IHC to study seven kidney autopsy samples.

RESULTS

Of the 57 patients, 19 had autoantibodies to kidney, with polyclonal reactivity (P < 0.01). Most cases were positive along the basement membrane of the proximal tubules, but in some cases there was also positivity against the glomeruli and/or mixed patterns. Fifteen patients had increases in serum urea and creatinine compared with controls (P < 0.01). The autoantibodies colocalized with commercial antibodies to desmoplakins I and II, p0071, armadillo repeat gene deleted in velo-cardio-facial syndrome (ARCVF) and myocardium-enriched zonula occludens-1-associated protein (MYZAP) (P < 0.01). All of the kidney disease autopsies showed alterations, mostly in the vessels.

CONCLUSION

We demonstrate for the first time that one-third of patients with El Bagre-EPF have polyclonal autoantibodies to kidney. The kidneys showed a mixed histological pattern resembling lupus nephritis, with a diffuse proliferative Class IV (G) global diffuse pattern in active lesions, and additional interposition of membranoproliferative glomerulonephritis.

Patients with a new variant of endemic pemphigus foliaceus have autoantibodies against arrector pili muscle, colocalizing with MYZAP, p0071, desmoplakins 1 and 2 and ARVCF

BACKGROUND

We identified a new variant of endemic pemphigus foliaceus in El Bagre, Colombia, South America, which we term El Bagre-EPF, and observed reactivity to arrector pili muscle (APM), thus we tested for autoimmunity to APM.

METHODS

We took skin biopsies from 30 patients with El Bagre-EPF and 30 healthy controls (HCs) matched by age, sex and occupation, who were all from the endemic area, and tested these using direct immunofluorescence (DIF), confocal microscopy, immunohistochemistry and immunoblotting (IB).

RESULTS

Of the 30 patients with El Bagre-EPF, 27 had autoantibodies to APM that colocalized with commercial antibodies to myocardium-enriched zonula occludens-1-associated protein (MYZAP), desmoplakin (DP)1 and DP2, plakophilin 4, and Armadillo repeat gene deleted in velo-cardio-facial syndrome (ARVCF) (P < 0.001, Fisher exact test). The positive staining also colocalized with Junctional Adhesion Molecule 1 (JAM-A), a control antibody for gap cell junctions. No HC samples were positive. In 27 of the 30 patients, serum that was APM-positive also displayed IB colocalization of their autoantibody molecular weights with the Progen antibodies (P < 0.001, Fisher exact test).

CONCLUSIONS

Patients affected by El Bagre-EPF have autoantibodies to APM, colocalizing with the antibodies MYZAP, ARVCF, p0071, DP1 and DP2, suggesting that these molecules are El Bagre-EPF antigens. Further, all of these antigens represent components of cell junctions, indicating that the immune response is directed, at least partially, against cell junctions. The immune response in patients affected by El Bagre-EPF is polyclonal, and it includes B and T lymphocytes, mast cells, IgG, IgA, IgM, IgD, IgE, fibrinogen, albumin, complement/C1q, C3c and C4.

Patients' perspective on choosing the emergency department for nonurgent medical care: a qualitative study exploring one reason for overcrowding

INTRODUCTION

For decades it has been known that patients use emergency departments for nonurgent care needs. This study was conducted to help determine how the health care community can assist patients achieve consistent health care while meeting the patient's perceived needs.

METHOD

A descriptive qualitative study was conducted based on interviews with 31 persons between 22 and 43 years of age following an ED visit for a nonurgent medical need. Exploration of the patient's perception was accomplished through open-ended questions in a structured interview format. Data were analyzed using content analysis.

RESULTS

Patients who participated in our study revealed 3 major themes: (1) They were unable to obtain an appointment with a primary care provider (PCP); (2) they were referred by the staff (not the doctor) in PCPs' offices to be evaluated in the emergency department; and (3) it took less of their time to be seen in the emergency department than it did to contact their PCP, only to then be told to go to the emergency department.

DISCUSSION

The findings of this study support the need for health care providers to find ways to provide nonurgent care in a timely and efficient manner. Multiple options for providing this care need to be conceived and evaluated.

p38 MAP kinase regulation of AP-2 binding in TGF-beta1-stimulated chondrogenesis of human trabecular bone-derived cells

Collagenase-treated, explanted human trabecular-bone chips are an excellent source of osteoblast-like cells. We have recently shown the multiple differentiation potential of these cells; in addition to osteogenesis and adipogenesis, these cells also undergo chondrogenesis when maintained as high-density pellet cultures (250,000 cells/pellet) in a serum-free, chemically defined medium stimulated with TGF-beta1 (10 ng/mL). In this investigation, we have analyzed how transactivating nuclear transcription factors, specifically AP-2 and SP-1, may interact with common cis-acting elements found in the regulatory region of cartilage-specific genes as part of the signal transduction mechanism of TGF-beta1 and p38 during chondrogenesis of human trabecular bone-derived multipotential cells. Both TGF-beta1 stimulation and p38 MAP kinase activation affect the binding of AP-2 as well as SP-1 to oligonucleotides with sequence similarity to the overlapping AP-2/SP-1 sites found in the putative 52-bp immediate upstream regulatory region and the 5'-untranslated region of the human aggrecan gene. Electrophoretic mobility shift assays show that TGF-beta1 treatment of the bone-derived cells inhibits AP-2 DNA binding but enhances the DNA binding ability of SP-1. Additionally, treatment of these TGF-beta1-stimulated cells with p38 MAP kinase inhibitor, SB203580, rescued the AP-2 DNA binding but did not affect SP-1 DNA binding. These findings indicate that AP-2 DNA binding is the target of both TGF-beta1 and p38 MAP kinase signaling pathways and suggest a possible signal transduction cascade whereby TGF-beta1 induction of chondrogenesis involves the activation of p38 MAP kinase and the subsequent inhibition of DNA binding by AP-2, thereby preventing the transcriptional repression of the aggrecan gene.

De novo CD5+ diffuse large B-cell lymphomas. A heterogeneous group containing an unusual form of splenic lymphoma

We reviewed our institutional experience with de novo CD5+, large B-cell lymphomas to determine whether they represent a distinct entity and are related to CD5+ small B-cell disorders. We identified 13 cases with multiparameter flow cytometry over a period of 58 months (5% of large B-cell lymphomas) in 7 females and 6 males. Three groups were identified. Group 1 (2 cases) had diffuse splenic red pulp involvement with a distinctive cordal pattern of infiltration, no other clinical evidence of mass disease, microscopic disseminated disease on further workup, and an identical immunoglobulin-negative immunophenotype. Group 2 cases (7 cases) were clinically and morphologically heterogeneous and had an immunophenotype resembling mantle cell lymphoma (FMC7-positive, CD23-). Group 3 (4 cases) had miscellaneous immunophenotypes, including one closely resembling chronic lymphocytic leukemia. Cyclin D1 was positive in only 1 of 10 evaluable cases (group 2). We conclude that CD5+ diffuse large B-cell lymphomas are heterogeneous; most cases do not seem to be related to chronic lymphocytic leukemia or mantle cell lymphoma. However, we identified a subgroup of primary splenic CD5+ large B-cell lymphoma with diffuse red pulp involvement and believe this may represent a distinct clinicopathologic entity.

Mycosis fungoides: classic disease and variant presentations

Mycosis fungoides is a peripheral non-Hodgkin's T-cell neoplastic process, representing the most common type of primary cutaneous malignant lymphoma. Neoplastic lesions classically show skin predilection and characteristic clinical and histologic features in patch, plaque, and tumor stages. In addition, several clinicopathologic variants of mycosis fungoides have been delineated, including poikiloderma atrophicans vasculare (parapsoriasis variegata), Sézary syndrome, granulomatous mycosis fungoides, hypopigmented mycosis fungoides, folliculocentric mycosis fungoides, syringotropic mycosis fungoides, and Woringer Kolopp disease. We will review the salient features of patch, plaque, and tumor stage mycosis fungoides in this article and follow with a discussion of these variant clinicopathologic presentations and of therapeutic modalities.