Development Of Clinical Pathway Research Articles

Corrected to uncorrected? The metabolic conundrum of hypertrophic pyloric stenosis

ObjectivesThe purpose of this study was to evaluate factors associated with repeat blood testing after establishment of normal metabolic parameters and factors associated with reversal of metabolic correction back an uncorrected form in preoperative management of infants with Hypertrophic Pyloric Stenosis (HSP). MethodsA retrospective review of infants with HSP undergoing repeat serum chemistries after already having normal labs were identified. Variables associated with repeating normal bloodwork and reversion of normal to abnormal labs were identified. Associations between reversion to abnormal and ordering of repeat labs were determined. Results255 cases were studied with a median of 2 lab tests drawn per patient (range 1–9). Of 142 serum chemistry tests repeated after a normal test, 27% became abnormal, most commonly hyperkalemia. 61% of these went to surgery. No variables were associated with a normal test becoming abnormal. However, a time lapse of >12h was associated with the reordering of bloodwork despite it already being normal. ConclusionsThere is little evidence to support need for repeat serum chemistry testing in cases of HPS once normality has been established. Development of clinical pathways to reduce the use of unnecessary serum testing may improve efficiency of patient care and limit unnecessary resource utilization. Level of evidenceRetrospective Case control: 3b.

A Study of Comparative Clinical and Socio-Economic Characteristics of School-Age Children Screened for ADHD: Implications for Development of ADHD Clinical Care Pathway

ADHD is the most frequently occurring neurobiological disorder in childhood and is defined by cardinal symptoms of inattention and/or hyperactivity and impulsivity. We evaluated school-age children referred for behaviour problems and screened for ADHD over a 22-month period. We compared the clinical and socio-economic characteristics of the two groups of children: those diagnosed with ADHD and non-ADHD. A total of 63 children were assessed for possible ADHD over the period. There was no statistically significant difference between both groups in relation to several characteristics including sex ratio, mean age at referral and diagnosis, mean number of clinics attended, the time taken to complete the assessment and the socioeconomic status of patients’ families. The highest proportion of the ADHD and non-ADHD children lived in the most deprived areas. The main difference between both groups was the high rate of negative teachers’ responses. No teacher’s rating was positive for any child without a diagnosis. An ideal ADHD care pathway should follow multi-disciplinary approach, and rely on evidence-based feedback from the school, as a more reliable pointer to confirmed diagnosis of ADHD compared to just parental report. This will likely reduce assessment duration and avoid delays in diagnosis confirmation.

Analysis of nurse navigators\u2019 activities for hospital discharge coordination: a mixed method study for the case of cancer patients

BackgroundModern cancer care requires the development of clinical pathways to enhance coordination, but there are few descriptive studies about the content of coordination activities. More specifically, little is known about hospital discharge coordination, although this is seen as a sensitive phase of clinical pathway.PurposeThe purpose of this study was to identify and quantify the categories of activities performed by nurse navigators for hospital discharge coordination.MethodsPatients supported within the Coordinating Outpatient Care department (COC) at Gustave Roussy (Villejuif, France). Study conducted over two consecutive phases (Feb-September 2014): (1) a qualitative phase to identify the categories of coordination activities (interviews with patients plus, focus groups with nurse navigators—NNs); (2) a quantitative phase to quantify the relative share of each category. The calls received through the telephone platform of COC (made by both patients and primary care providers) were systematically reported (caller; reason for the call; procedure performed) and then analyzed.ResultsQualitative phase: 17 interviews with patients, plus 2 focus groups with NNs. Quantitative phase: 543 calls analyzed. The callers were patients or their relatives (38 %), private nurses (35 %), medical device providers (20 %), and other primary care providers (e.g., pharmacists, family physicians) (7 %). Five categories of coordination activities identified: (F1) Patient monitoring (29 %); (F2) Helping to navigate (24 %); (F3) Managing technical problems (17 %); (F4) Explaining care protocols (16 %); (F5) Collecting and transmitting the patient medical record information (14 %).ConclusionsThe majority of requirements are related to organizational issues (e.g., navigation, lack of information, appointments). Nurse navigators’ training and qualification must therefore combine both clinical and managerial skills.

Translational research: The ingredients are only the start of the recipe for better dietetic practice

Translational research: The ingredients are only the start of the recipe for better dietetic practice

The eClinical Care Pathway Framework: a novel structure for creation of online complex clinical care pathways and its application in the management of sexually transmitted infections.

BackgroundDespite considerable international eHealth impetus, there is no guidance on the development of online clinical care pathways. Advances in diagnostics now enable self-testing with home diagnosis, to which comprehensive online clinical care could be linked, facilitating completely self-directed, remote care. We describe a new framework for developing complex online clinical care pathways and its application to clinical management of people with genital chlamydia infection, the commonest sexually transmitted infection (STI) in England.MethodsUsing the existing evidence-base, guidelines and examples from contemporary clinical practice, we developed the eClinical Care Pathway Framework, a nine-step iterative process. Step 1: define the aims of the online pathway; Step 2: define the functional units; Step 3: draft the clinical consultation; Step 4: expert review; Step 5: cognitive testing; Step 6: user-centred interface testing; Step 7: specification development; Step 8: software testing, usability testing and further comprehension testing; Step 9: piloting. We then applied the Framework to create a chlamydia online clinical care pathway (Online Chlamydia Pathway).ResultsUse of the Framework elucidated content and structure of the care pathway and identified the need for significant changes in sequences of care (Traditional: history, diagnosis, information versus Online: diagnosis, information, history) and prescribing safety assessment. The Framework met the needs of complex STI management and enabled development of a multi-faceted, fully-automated consultation.ConclusionThe Framework provides a comprehensive structure on which complex online care pathways such as those needed for STI management, which involve clinical services, public health surveillance functions and third party (sexual partner) management, can be developed to meet national clinical and public health standards. The Online Chlamydia Pathway’s standardised method of collecting data on demographics and sexual behaviour, with potential for interoperability with surveillance systems, could be a powerful tool for public health and clinical management.

Strengthening maternal immunisation to improve the health of mothers and infants

Strengthening maternal immunisation to improve the health of mothers and infants

A Primer on Clinical Pathways.

Leaders in health-system pharmacy are challenged to maintain the highest quality pharmacy service at the lowest cost. Clinical pathways are evidence-based road maps that assist in reducing variations in clinical practice. Integration of clinical pathways within the electronic health record further helps to facilitate evidence-based practice. This article reviews the evolution of the clinical pathways, describes their clinical and economic impact, and identifies ways pharmacy directors can successfully implement these pathways into their institutions. Pharmacy directors can utilize their skills in this area or task clinical pharmacists to serve as members of the clinical pathway development team to further enhance patient-centered pharmacy services.

The Effectiveness of Nurse-Led Preoperative Assessment Clinics for Patients Receiving Elective Orthopaedic Surgery: A Systematic Review

Nurse-led preoperative assessment clinics (POAC) have been introduced in different specialty areas to assess and prepare patients preoperatively in order to avoid last-minute surgery cancellations. Not all patients are referred to POACs before surgery, and the benefits of nurse-led POACs are not well documented in Hong Kong. The purpose of this systemic review was to identify the best available research evidence to inform current clinical practice, guide health care decision making and promote better care. The Joanna Briggs Institute (JBI) approach for conducting systematicreview of quantitative research was used. Data bases searched included all published and unpublished studies in Chinese and English. All studies with adult patients who required elective orthopaedic surgery e.g. total knee replacement, total hip replacement, reduction of fracture or reconstruction surgery etc. in a hospital or day surgery center and attended a nurse-led POAC before surgery were included. Ten studies were critically appraised. Results showed that nurse-led POACs can reduce surgery cancellation rates. These studies suggested a reduction in the rate of postoperative mortality and length of hospital stay. In addition, the level of satisfaction towards services provided was significantly high. Although POACs are being increasingly implemented worldwide, the development of clinical guidelines, pathways and protocols was advocated. The best available evidence asserted that nurses in the POAC could serve as effective coordinators, assessors and educators. The nurse-led practice optimized patients' condition before surgery and hence minimized elective surgery cancellations.

The patient experience of having a stoma and its relation to nursing practice: implementation of qualitative evidence through clinical pathways

The aim of this article is to explore patients' experiences of having a stoma, in particular those relating to: emotion and social issues; changes in quality of life; feelings of fear, shame or frustration because of the altered lifestyle; and changes in roles and relationships and in their social environment. This article is part of a research project that employs a three-step method, including a metasynthesis method for international qualitative research, the development of clinical pathways for nursing diagnoses, interventions and outcomes, and the implementation and evaluation of these clinical pathways. This article describes the first phase of the research. The results show that, internationally, there are many similarities in the ways in which individuals with a stoma cope with having a stoma.

Effect of Development of Clinical Pathway on Post-operative complications for Colorectal Surgery Patients

Colorectal surgery is associated with sizeable morbidity and, for emergency surgery, considerable mortality. Clinical pathways ensure consistency in the management of patients by their streamlined approach to patient care. Aim: The present study aimed to determine the effect of the development of clinical pathway on post-operative complications for colorectal surgery patients. Materials: A quasi- experimental research design was utilized to fulfill the aim of this study. Data were collected from general surgery department and cancer institute at Aswan governorate. Sample: Patients admitted in general surgery department who had undergone colorectal surgery 60 patients were included in the study (30 patients in the study group and 30 patients in the control group), the mean age of the study group and control group was (52.1+6.5 & 49.7+4.7) years respectively. Tools: (1) Perioperative colorectal surgery patient assessment, (2) Clinical pathway variances assessment. Conclusion: Significant difference was observed between study and control group as regard hospital length of stay also significant difference was found between the study and control groups in relation to occurrence of postoperative complications. The study Recommended that, colorectal surgery clinical pathway be used rather than the traditional delivery of care

The association of psychosocial screening and service provision in pediatric oncology: the Psychosocial Assessment Tool (PAT2.0) into clinical practice.

Distress screening in oncology has been widely endorsed in recent years. However, current knowledge of the impact of screening on delivery of clinical psychosocial services is limited. This study investigated the association between screening and psychosocial services in the early period following diagnosis of childhood cancer. The Psychosocial Assessment Tool (PAT2.0) was administered by clinical social workers in two pediatric oncology centers shortly following diagnosis. Psychosocial service activity in the first 8weeks post diagnosis was collected via social work surveys and extraction of information from hospital databases. PAT2.0 and psychosocial service data were obtained for 89 families with a child newly diagnosed with cancer. Distribution of PAT2.0 risk categories was consistent with previous studies (57.3% universal, 38.2% targeted, 4.5% clinical). Significant, weak to moderate correlations between PAT2.0 and social workers' estimates of psychosocial risk were observed. No significant differences in the amount of psychosocial services provided to families with "universal" versus "elevated" (i.e., targeted or clinical) risk were found. Number of days in hospital was strongly and positively associated with the amount of psychosocial services families received in the first 8weeks following diagnosis. Psychosocial risk, as measured by the PAT2.0, and allocation of psychosocial services were not significantly associated in the early period following diagnosis. Further investigation is required to understand if differences emerge over time when psychosocial screening is implemented clinically. Development of clinical pathways of care needs to account for patients who may predominantly be treated in the outpatient setting.

The Effect of a Clinical Pathway Strategy for Managing Care in Total Joint Replacement: The Impact on Perioperative Outcomes

Introduction: The development of clinical pathways, for a variety of surgical procedures, has made an impact on clinical practice. When combined with the electronic medical record, clinical pathways can bring uniformity in orders and protocols designed to reduce error, decrease variability, and promote patient outcomes and safety. Our hypothesis is that the use of a modern evidence based clinical pathway will produce improved clinical outcomes in total joint replacement patients. Methods: All patients undergoing primary total hip or knee replacement were selected to be included in this study. All participants were prospectively enrolled. As part of our clinical follow up, patients were assessed during their preoperative clinic visit and were followed 90 days postoperatively. Patient reported outcome measures were utilized to assess patient satisfaction and objective clinical outcomes. Results: This report includes 102 patients who were followed for their progress while on the pathway. Overall there was an improvement in most of the measured outcome mean scores. There was a significant mean difference between preoperative and postoperative outcome measure scores for the following surveys: Harris Hip Score, Hip Knee Expectations Survey, HOOS Hip Score KOOS Knee Survey, Knee Society Score, WOMAC, SF-12, and UCLA Activity Score. Discussion: We concluded that clinical pathways are a reliable tool that monitors the inpatient experience and processes of care in orthopedic surgery. The pathways support the accountability for outcomes of care and have proven superior to retrospective review and traditional quality assurance techniques.

Ethics of scientific publication.

Published scientific research breeds the development of clinical management guidelines and pathways. Currently, scholarly proficiency is assessed using numerous primitive metrics for incentives that can kindle publication of hoax or flawed research content. Such flawed data can lead to wastage of resources, time, and most importantly harm to the society. Authors, editors, and peer reviewers need to be genuine in conducting, analyzing, and publication of scientific research. Institutions need to be aware and utilize advanced metrics to assess the scientific reputation of researchers. This short review discusses in brief the common authorship and editorial ethical issues encountered in scientific publication and the newer metrics available for the assessment of scholarly excellence. Editors and peer reviewers need to be acquainted with the common ethical issues and follow consensus international guidelines on publication ethics to tackle them appropriately.

Transitions in the Prophylaxis, Treatment and Care of Patients with Venous Thromboembolism.

IntroductionPatients experience numerous transitions, including changes in clinical status, pharmacologic treatment and prophylaxis, and progression through the physical locations of their healthcare setting as they advance through a venous thromboembolism (VTE) clinical experience. This review provides an overview of these transitions and highlights how they can impact clinical care.MethodsMajor public resources (PubMed, MEDLINE, and Google Scholar) were searched using various combinations of the terms: “venous thromboembolism”, “deep vein thromboses”, “pulmonary embolism”, “transitions in care”, and “hospital protocols” to identify narrative reviews, professional guidelines, or primary manuscripts reporting protocol development strategies and/or clinical data, published in English from 2010 through January 2015. The studies included in this review were selected on the basis of extensive reading of the literature and the author’s clinical expertise.ResultsVTE treatment and prophylaxis is a dynamic process requiring ongoing patient assessments and adjustments to therapeutic strategies as the patient progresses through various hospital and outpatient settings. Throughout these transitions in care, physicians need to be vigilant of any changes in the patient’s clinical condition which may impact the patient’s risk of VTE, and re-evaluate the intervention(s) employed when such changes occur. A standardized, interdisciplinary VTE clinical pathway developed for medical patients with acute VTE resulted in decreased utilization of hospital resources and healthcare costs, suggesting that further research is warranted in this area.ConclusionThe prevention and management of VTE can be optimized by the development and local implementation of standardized evidence-based clinical pathways.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0271-8) contains supplementary material, which is available to authorized users.

Evaluation of a Clostridium difficile infection management policy with clinical pharmacy and medical microbiology involvement at a major Canadian teaching hospital.

Clostridium difficile infection (CDI) represents a spectrum of disease and is a significant concern for healthcare institutions. Our study objective was to assess whether implementation of a regional CDI management policy with Clinical Pharmacy and Medical Microbiology and Infection Control involvement would lead to an improvement in concordance in prescribing practices to an evidence-based CDI disease severity assessment and pharmacological treatment algorithm. Conducted at a tertiary care teaching hospital, this two-phase quality assurance study consisted of a baseline retrospective healthcare record review of patients with CDI prior to the implementation of a regional CDI management policy followed by a prospective evaluation post-implementation. One hundred and forty-one CDI episodes in the pre-implementation group were compared to 283 episodes post-implementation. Overall treatment concordance to the CDI treatment algorithm was achieved in 48 of 141 cases (34%) pre-implementation compared with 136 of 283 cases (48·1%) post-implementation (P = 0·01). The median time to treatment with vancomycin was reduced from five days to one day (P < 0·01), with median length of hospital stay decreasing from 30 days to 21 days (P = 0·01) post-implementation. There was no difference in 30-day all-cause mortality. A comprehensive approach with appropriate stakeholder involvement in the development of clinical pathways, education to healthcare workers and prospective audit with intervention and feedback can ensure patients diagnosed with CDI are optimally managed and prescribed the most appropriate therapy based on CDI disease severity.

Paving the COWpath: Learning and visualizing clinical pathways from electronic health record data

ObjectiveClinical pathways translate best available evidence into practice, indicating the most widely applicable order of treatment interventions for particular treatment goals. We propose a practice-based clinical pathway development process and a data-driven methodology for extracting common clinical pathways from electronic health record (EHR) data that is patient-centered, consistent with clinical workflow, and facilitates evidence-based care. Materials and methodsVisit data of 1,576 chronic kidney disease (CKD) patients who developed acute kidney injury (AKI) from 2009 to 2013 are extracted from the EHR. We model each patient’s multi-dimensional clinical records into one-dimensional sequences using novel constructs designed to capture information on each visit’s purpose, procedures, medications and diagnoses. Analysis and clustering on visit sequences identify distinct types of patient subgroups. Characterizing visit sequences as Markov chains, significant transitions are extracted and visualized into clinical pathways across subgroups. ResultsWe identified 31 patient subgroups whose extracted clinical pathways provide insights on how patients’ conditions and medication prescriptions may progress over time. We identify pathways that show typical disease progression, practices that are consistent with guidelines, and sustainable improvements in patients’ health conditions. Visualization of pathways depicts the likelihood and direction of disease progression under varied contexts. Discussion and conclusionsAccuracy of EHR data and diversity in patients’ conditions and practice patterns are critical challenges in learning insightful practice-based clinical pathways. Learning and visualizing clinical pathways from actual practice data captured in the EHR may facilitate efficient practice review by healthcare providers and support patient engagement in shared decision making.

Delayed Hyponatremia Is the Most Common Cause of 30-Day Unplanned Readmission After Transsphenoidal Surgery for Pituitary Tumors.

Unplanned readmission after surgical procedures is an important quality metric. Yet, readmission rates and causes have not been evaluated for patients after transsphenoidal surgery for pituitary tumors. To analyze unplanned 30-day readmissions at a pituitary center and to encourage the development of effective clinical pathways to prevent readmission. A retrospective review of adult patients who underwent transsphenoidal surgery for pituitary lesions at Barrow Neurological Institute (January 2011-March 2014) was performed to identify causes of unplanned readmission within 30 days of surgery. Patient demographics, tumor details, surgical complications, and endocrine function were documented. Of 303 patients who had transsphenoidal surgery, 27 (8.9%) were readmitted within 30 days. Most of the 27 (15 [55.6%]) had delayed hyponatremia. Other causes were diabetes insipidus (4 [14.8%]), adrenal insufficiency (2 [7.4%]), and cerebrospinal fluid leak, epistaxis, cardiac arrhythmia, pneumonia, urinary tract infection, and hypoglycemia (1 each [3.7%]). Outpatient sodium screening was performed as needed. In cases of hyponatremia, the mean postoperative day of readmission was day 8 (range, 6-12 days) and the mean serum sodium was 119 mmol/L (range, 111-129 mmol/L). Numerous patient and surgical factors were examined, and no specific predictors of readmission were identified. We developed an outpatient care pathway for managing hyponatremia with the goal of improving readmission rates. This study establishes a quality benchmark for readmission rates after transsphenoidal surgery for pituitary lesions and identifies delayed hyponatremia as the primary cause. Implementation of an outpatient care pathway for managing hyponatremia may improve readmission rates.

Online clinical pathway for managing adults with chronic kidney disease

Around one-tenth of the adults in Canada are affected by chronic kidney disease (CKD), which is defined as estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2.1 Early recognition of CKD is important, since timely implementation of lifestyle and pharmacological interventions can prevent it or slow its progression.2-4 Such interventions can also reduce the incidence of cardiovascular disease (CVD)5,6—the primary cause of death in these patients.7 However, patients with CKD are often not recognized and do not receive optimal treatment because of complexities in care and failure to disseminate best practices.8-10 The Kidney Disease Improving Global Outcomes (KDIGO) CKD clinical practice guidelines provide evidence for the evaluation and management of CKD.11 While clinical practice guidelines summarize evidence and provide recommendations, they are often difficult to apply in routine daily clinical activities. Clinical pathways are often derived from clinical practice guidelines but differ by providing more explicit and practical information about the sequence, timing and provision of interventions.12 A clinical pathway can be an effective tool to increase uptake of evidence-based health care by pharmacists and other primary care professionals in the community, who care for the majority of patients with CKD.13-15 Pharmacists in Canada have an expanding scope of practice; pharmacists can order laboratory tests, adapt new prescriptions, perform therapeutic substitutions, issue prescriptions for continuity of care and prescribe in emergency situations.16 In Alberta, pharmacists who have Additional Prescribing Authorization can prescribe at initial access or manage ongoing therapy based on their own assessment or in collaboration with another regulated health care professional.17 An integral part of pharmacists’ practice is working collaboratively and communicating with physicians and other health care providers.17 As pharmacists’ expanded scope of practice develops,16 tools such as the CKD Clinical Pathway (Figure 1) can assist pharmacists to implement evidence-based guidelines into their daily practice. This manuscript provides an overview of the clinical pathway for diagnosis, management and referral of adults with CKD and its potential clinical use for pharmacists. Figure 1 Overview of the adult CKD Clinical Pathway Development of the adult CKD Clinical Pathway The CKD Clinical Pathway is an online tool/guideline modeled after the successful National Institute for Health and Clinical Excellence (NICE) clinical pathways (http://pathways.nice.org.uk). It was developed by a team of stakeholders that included pharmacists, nephrologists, primary care physicians, nurses, other health care professionals, IT specialists, web developers and designers. Usability and heuristic testing with primary care professionals has been completed, and the CKD Clinical Pathway has been available online since November 4, 2014 (www.CKDpathway.ca). The content in the CKD Clinical Pathway is evidence based and uses international and national guidelines, including the KDIGO CKD guidelines,11 KDIGO Lipid guidelines,18 C-CHANGE,19 Canadian Diabetes Association (CDA) guidelines,20 Canadian Cardiovascular Society Lipid and Antiplatelet guidelines21,22 and Canadian Hypertension Education Program guidelines.23 This ensures that the recommendations are relevant and harmonized across Canada. Some of the content, such as the specialist referral form, is tailored to practice in Alberta. Users of the pathway should be aware that their local laboratory may report different reference ranges and units of measure than the laboratories in Alberta. Currently, laboratories in Alberta report estimated GFR using the CKD-EPI equation.24

Improving nursing research activity: the importance of leadership.

British Journal of NursingVol. 24, No. 14 RegularsImproving nursing research activity: the importance of leadershipDebbie Carrick-Sen, Lesley Baillie, Christi Deaton, Lesley Lowes, Candy McCabe, Christine Norton, Angela Tod, Elizabeth RobbDebbie Carrick-SenSearch for more papers by this author, Lesley BaillieSearch for more papers by this author, Christi DeatonSearch for more papers by this author, Lesley LowesSearch for more papers by this author, Candy McCabeSearch for more papers by this author, Christine NortonSearch for more papers by this author, Angela TodSearch for more papers by this author, Elizabeth RobbSearch for more papers by this authorDebbie Carrick-Sen; Lesley Baillie; Christi Deaton; Lesley Lowes; Candy McCabe; Christine Norton; Angela Tod; Elizabeth RobbPublished Online:23 Jul 2015https://doi.org/10.12968/bjon.2015.24.14.751AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Association of UK University Hospitals (2013) Report of the AUKUH National Clinical Academic Careers Development Group for Nurses and Midwives. http://tinyurl.com/o62kxdw (accessed 10 July 2015) Google ScholarCare Quality Commission (2014) Care Quality Commission Annual Report 2013 – 2014. http://www.cqc.org.uk/content/cqc-annual-report-201314 (accessed 10 July 2015) Google ScholarCouncil of Deans for Health (2012) Clinical Academic Careers for Nursing, Midwifery and the Allied Health Professions, Council of Deans of Health position statement. http://tinyurl.com/nwmut5d (accessed 10 July 2015) Google ScholarHealth Education England (2015) Raising the Bar: Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants. Lord Willis, Independent Chair – Shape of Caring review. http://tinyurl.com/q8wrttv (accessed 10 July 2015) Google ScholarMedical Schools Council (2011) Staffing Levels of Medical Clinical Academics in UK Medical Schools as at 31 July 2010. A report by the Medical Schools Council. http://tinyurl.com/oo8aq5x (accessed 10 July 2015) Google ScholarWestwood G, Fader M, Roberts L, et al. (2013) How clinical academics are transforming patient care. Heath Service Journal online. http://tinyurl.com/q5l7mks (accessed 10 July 2015) Google Scholar FiguresReferencesRelatedDetailsCited byA translational research framework for nurse practitioners4 November 2021 | Journal of Nursing Management, Vol. 30, No. 2Interventions and strategies aimed at clinical academic pathway development for nurses in the United Kingdom: A systematised review of the literature2 February 2021 | Journal of Clinical Nursing, Vol. 30, No. 11-12A nationwide initiative to increase nursing and midwifery research leadership: overview of year one programme development, implementation and evaluation28 November 2020 | Journal of Clinical Nursing, Vol. 71A survey identifying leadership and research activities among Nurse Practitioners28 October 2020 | Contemporary Nurse, Vol. 56, No. 5-6An international focus on cardiac surgery nursing: clinical academic careersJulie Sanders, Rochelle Wynne, Geraldine Martorella, Suzanne Fredericks8 June 2020 | British Journal of Cardiac Nursing, Vol. 15, No. 6An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective16 April 2019 | Journal of Clinical Nursing, Vol. 26An overview of research in orthopaedic and trauma nursingInternational Journal of Orthopaedic and Trauma Nursing 23 July 2015Volume 24Issue 14ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 23 July 2015 Published in print 23 July 2015 Information© MA Healthcare LimitedPDF download

Vaccination With a Highly Attenuated Recombinant Vesicular Stomatitis Virus Vector Protects Against Challenge With a Lethal Dose of Ebola Virus.

Previously, recombinant vesicular stomatitis virus (rVSV) pseudotypes expressing Ebolavirus glycoproteins (GPs) in place of the VSV G protein demonstrated protection of nonhuman primates from lethal homologous Ebolavirus challenge. Those pseudotype vectors contained no additional attenuating mutations in the rVSV genome. Here we describe rVSV vectors containing a full complement of VSV genes and expressing the Ebola virus (EBOV) GP from an additional transcription unit. These rVSV vectors contain the same combination of attenuating mutations used previously in the clinical development pathway of an rVSV/human immunodeficiency virus type 1 vaccine. One of these rVSV vectors (N4CT1-EBOVGP1), which expresses membrane-anchored EBOV GP from the first position in the genome (GP1), elicited a balanced cellular and humoral GP-specific immune response in mice. Guinea pigs immunized with a single dose of this vector were protected from any signs of disease following lethal EBOV challenge, while control animals died in 7–9 days. Subsequently, N4CT1-EBOVGP1 demonstrated complete, single-dose protection of 2 macaques following lethal EBOV challenge. A single sham-vaccinated macaque died from disease due to EBOV infection. These results demonstrate that highly attenuated rVSV vectors expressing EBOV GP may provide safer alternatives to current EBOV vaccines.