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Vascular Dysfunction in Women With a History of Preeclampsia and Intrauterine Growth Restriction Insights. Serum measurements of free. Ramsay et al 47 have reported that endothelial cell activation markers were. A hallmark of preeclampsia is endothelial cell dysfunction/activation. Vitamin D Prevents Endothelial Progenitor Cell Dysfunction Induced by Sera from Women with Preeclampsia or Conditioned Media from Hypoxic Placenta. Endothelial colony forming cells (ECFC), a sub- population of endothelial progenitor cells (EPCs), are thought to be involved in vasculogenesis and endothelial repair. Low vitamin D concentrations are associated with an increased risk for preeclampsia. Objective: We hypothesized that the function of human fetal ECFCs in culture would be suppressed by exposure to preeclampsia- related factors. Design, Setting, Patients: ECFCs were isolated from cord blood of uncomplicated pregnancies and expanded in culture. Uncomplicated pregnancy villous placenta in explant culture were exposed to either 2% (hypoxic), 8% (normoxic) or 2. O2 for 4. 8 h, after which the conditioned media (CM) was collected. Outcome Measures: ECFC tubule formation (Matrigel assay) and migration were examined in the presence of either maternal serum from preeclampsia cases or uncomplicated pregnancy controls, or pooled CM, in the presence or absence of 1,2. OH)2 vitamin D3. Results: 1,2. OH)2 vitamin D3 reversed the adverse effects of preeclampsia serum or CM from hypoxic placenta on ECFCs capillary- tube formation and migration. Silencing of VDR expression by VDR si. RNA, VDR blockade, or VEGF pathway blockade reduced ECFC functional abilities. Effects of VDR or VEGF blockade were partially prevented by vitamin D. Conclusion: Vitamin D promotes the capillary- like tubule formation and migration of ECFCs in culture, minimizing the negative effects of exposure to preeclampsia- related factors. Further evaluation of the role of vitamin D in ECFC regulation and preeclampsia is warranted.
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Like every healthcare system today, the Cleveland Clinic health system is a combination of medical hospitals, institutes, and services in which the implementation of uniform care methodologies faces significant barriers. The guiding principle of the Cleveland Clinic, . The Stanley Shalom Zielony Institute of Nursing Excellence (the Nursing Institute) at the Cleveland Clinic was charged with standardizing nursing practice across a system with 1. The challenge involved providing firm direction on delivering PFCC that was appropriate for all clinical disciplines and could be implemented quickly across existing practices and technologies. Successful implementation required full engagement in the concept of PFCC by what the Institute for Healthcare Improvement has termed the . To achieve these ends, development of a systemwide nursing practice model was initiated. In this article the authors identify the essence of PFCC, consider barriers to PFCC, review their process of developing PFCC, and describe how the Cleveland Clinic health system has implemented a PFCC nursing practice model. In doing so the authors explore how the concept of ! Engaging the Hearts and Minds of Nurses with a Patient- Centered Practice Model. DOI: 1. 0. 3. 91. Welcome to the Minnesota Unemployment Insurance (UI) Program This is the official website of the Minnesota Unemployment Insurance Program, administered by the Department of Employment and Economic Development (DEED). Enterprise architect career path has bright and dark sides. IASA CEO Paul Preiss discusses how the digital transformation and technology advances are the drivers creating opportunities in the burgeoning enterprise architecture. The Web Platform Working Group has published a Proposed Recommendation of WebIDL Level 1. This document defines an interface definition language, Web IDL, that can be used to describe interfaces that are intended to be. OJIN. Vol. 16. No. Man. 02 Key words: barriers to PFCC, care delivery model, Cleveland Clinic health system, implementation of a model of PFCC, nursing practice model, patient- family- centered care, PFCC, passion for nursing,Care at the Cleveland Clinic has been always centered on patients. In 1. 92. 1 the founders of the Cleveland Clinic envisioned a patient- focused environment that delivered . The Cleveland Clinic, like every healthcare system today, is a complex combination of medical hospitals, institutes, and services where existing technologies and conflicting priorities can create significant barriers to standardizing care quality. The Stanley Shalom Zielony Institute of Nursing Excellence (the Nursing Institute) is responsible for raising the quality of nursing care at the Cleveland Clinic. It has adopted the motto . The leadership of the Nursing Institute recognized the need for a systemwide nursing practice model to guide nurses in achieving the Cleveland Clinic vision and demonstrated the commitment of nursing leadership to PFCC. In this article we will identify the essence of PFCC, consider barriers to PFCC, review the process of developing a PFCC- based nursing practice model, and describe how the Cleveland Clinic health system has implemented a nursing practice model of PFCC. Identifying the Essence of Patient- and Family- Centered Care.. Organizational managers who are trying to implement patient- and family- centered care strategies will quickly face the problem of defining PFCC within their organization, the hardest problem for every organization working to implement PFCC. Since the Institute of Medicine (IOM) identified . A search of MEDLINE literature shows 7,1. A common theme in these publications is the lack of a universal definition (Balik, Conway, Zipperer, & Watson, 2. Hobbs, 2. 00. 9; Mead & Bower, 2. There is no universal definition of PFCC because the definition changes with the context in which it. For example, family practice, cancer care, and acute care all have multiple articles with slightly different definitions relevant to their particular research issues. The Institute for Patient- and Family- Centered Care (2. PFCC. However, a single, simple description of patient- and family- centered care may not suit the needs of a complex health system. Even the smallest modern health system is a collection of diverse services that can include acute care in urban and rural settings, inpatient care, urgent care, trauma care, home health care, and hospice care. Robinson, Callister, Berry, and Dearing (2. They concluded that regardless of your specific definition, the basic measuring stick of PFCC is the patient. Nurses play one of the most important roles in influencing patient perceptions. Nurses play one of the most important roles in influencing patient perceptions. After completing a large study of patient ratings of their hospital experiences, Otani (2. In this study Otani evaluated the admission process, nursing care, physician care, staff care, food, and room, and concluded that a bad nursing experience had a disproportionate negative result on quality perceptions. Otani recommended that managers should make as their first priority the elimination of poor nursing practice. Health systems like the Cleveland Clinic are faced with trying to encourage better patient- and family- centered care while knowing that each decentralized location (and even each unique unit within a location) will have a slightly different view on exactly what PFCC means to their patients. With over 2,0. 00 employed doctors, 1. RNs), and more than 8. APNs), plus 3. 0,0. Cleveland Clinic may prevent some patients from actually receiving PFCC. Hence the Cleveland Clinic has established . This principle guides the thinking of the managers of the institutes, specialized hospitals, and outpatient facilities which are expected to develop appropriate policies and procedures to handle the unique issues within their facility so that they deliver the world- class care that is the Cleveland Clinic. The first barrier is the fact that existing technologies and policies across the system are not uniform; the second is that the model must work for all medical specialties, just as with the definition of PFCC; and the third barrier is getting nurses engaged so they accept and implement PFCC policies that require specific types of personal interaction by individual nurses. Because these barriers are not unique to the Cleveland Clinic, a detailed discussion is provided below. Non- Uniform Technology and Policies. Although it may be unnecessary to agree on a detailed definition of patient- and family- centered care, health systems do need to implement uniform best practices as quickly as possible if they're going to deliver consistent PFCC. Waiting for existing technologies at the different units of a health system to be standardized can significantly slow down the implementation of consistent PFCC policies. Many health systems have grown through mergers and acquisitions and face the cost and delays of standardizing policies across significantly different technologies. This represents 1. American Hospital Association (AHA) (2. United States (US). The Cleveland Clinic is a merged system, consisting of 1. Ohio, of which 1. Cleveland Clinic hospital through acquisition or joint operating agreements. In addition, there are many offsite care delivery facilities and support operations in northeast Ohio, such as home health and ambulatory surgery centers. There are also hospitals and operations in other states and countries where nursing practice needs to be guided by a nursing practice model. Cleveland Clinic currently has numerous technologies and policies that are unique to specific areas, most of which are in the process of being standardized. Faster standardization of PFCC requires independence from other standardization projects. Implementation must be done via paper and the Internet, supported by onsite training, ongoing education, and role modeling. Variety of Medical Specialties and Roles. Nurses perform a variety of roles; yet existing health system practice models are often focused on a single role, namely that of the bedside nurse in a hospital setting. A nursing practice model needs to give guidance that will help nurses perform in a variety of roles, from direct caregiver to central coordinator of care to supporting team member in any of the multiple facilities. Nursing Engagement. Successful implementation of PFCC requires more than just standardized models, policies, and procedures that tell nurses how to apply their knowledge and skills; it also requires managers to motivate nurses to apply them vigorously. Successful implementation of PFCC requires more than just standardized models, policies, and procedures that tell nurses how to apply their knowledge and skills; it also requires managers to motivate nurses to apply them vigorously. An Institute of Healthcare Improvement Innovation Series white paper by Balik, Conway, Zipperer, and Watson (2. Another key driver was . This driver is consistent with the Cleveland Clinic vision and guiding principle. The remaining key drivers were respectful partnership, reliable care, and evidence- based care. The Cleveland Clinic has recognized that nursing engagement is crucial for successful implementation of PFCC and measures this experience with the Gallup Organization. Nursing engagement has been linked to better patient outcomes. Increases in nursing engagement scores have been shown to have a greater effect on patient outcomes than increases in nurse staffing (measured as the ratio of the number of nurses to total patient days) (Blizzard, 2. Development of the Nursing Practice Model. Nurses across the system wanted to have their roles better defined and to be more empowered so as to deliver better care. In 2. 00. 9, the head of the Nursing Institute, Executive Chief Nursing Officer (ECNO) Sarah Sinclair, established a system- wide organization with four Associate Chief Nursing Officers (ACNOs), respectively responsible for Clinical Practice and Research; Informatics; Clinical Education and Professional Development; and Care Management and Social Work. The organization also includes a Human Resource Business Partner and System Executive/Director of Nursing Operations Integration, both of whom reported to the ECNO. 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