Background: Healthcare systems increasingly require nurse leaders who combine clinical expertise with business acumen. Traditional Master of Science in Nursing (MSN) and Doctor of Nursing Practice (DNP) programs emphasize clinical and leadership skills but offer limited education in finance, strategy, and management. The Master of Business Administration (MBA) provides business competencies but lacks clinical content. A dual Doctor of Nursing Practice/Master of Business Administration (DNP/MBA) integrates both domains. Nationally, only 8.96% of institutions offer such a program, despite growing interest in business education for nurse leaders. Design: Cross-sectional descriptive national survey using convenience sampling. Purpose: To explore perspectives of graduate nursing faculty, Chief Nursing Officers (CNOs), and Chief Executive Officers (CEOs) on the value of the MSN, DNP, MBA, and DNP/MBA degrees in preparing nurse leaders. Methods: An electronic survey (Nov 2022-May 2025) yielded 477 responses (292 faculty, 130 CNOs, 55 CEOs). Content validity was established via expert review. Data were analyzed descriptively and comparatively using SurveyMonkey functions. Results: CEOs and CNOs expressed support for the DNP/MBA as integrating clinical and business competencies. Faculty strongly endorsed integrating business content. Findings reflect stakeholder preferences but should be interpreted cautiously given low response rates. Conclusion: The DNP/MBA was viewed as the most comprehensive preparation for nurse executives. While exploratory, stakeholder perspectives suggest the DNP/MBA may warrant consideration as a preferred credential and may eventually emerge as an expectation for C-Suite preparation.

BACKGROUND:Many graduate nursing students face persistent challenges in academic writing. These challenges have been further exacerbated by the development of artificial intelligence (AI) technologies, such as large language models (LLMs). This article aims to provide a heuristic guide for nursing faculty and administrators to examine their instructional practices in light of our reshaped technological landscape. METHOD:This article explores the effect of integrating AI tools in academic writing within the graduate nursing context, highlighting best practices of present scholarship and their application to the instructional contexts of graduate nursing programs. RESULTS:Strategies are offered for educators to use AI writing tools to complement traditional writing instruction, promote ethical AI use, and ensure equitable access to writing support. CONCLUSION:With effective guidance and well-crafted policies, AI writing tools can help graduate nursing students strengthen their writing skills, achieve academic success, contribute professionally, and drive legislative policy advancements.

BACKGROUND:The strongest genetic risk factors for atrial fibrillation (AF) are DNA variants on chromosome 4q25 near the transcription factor gene PITX2 (Pitx2:Paired-like homeodomain transcription factor 2). Mice deficient in Pitx2 (Pitx2+/-) have increased AF susceptibility, although the molecular mechanism(s) remains controversial. Pitx2 encodes a transcription factor that activates an antioxidant response to promote cardiac repair. Increased reactive oxygen species causing oxidation of polyunsaturated fatty acids generates reactive lipid dicarbonyl moieties that adduct to proteins and other macromolecules to promote cellular injury. We tested the hypothesis that oxidative stress, and specifically isolevuglandins, the most reactive lipid dicarbonyls identified, are increased in the setting of Pitx2 deficiency to promote proarrhythmic remodeling and AF.METHODS:Pitx2+/- and Pitx2+/+ wild-type littermate control mice were treated orally with vehicle, the lipid dicarbonyl scavenger 2-hydroxybenzylamine, or an inactive control compound at weaning, until study at age 16 to 18 weeks.RESULTS:Pitx2+/- mice demonstrated increased P wave duration indicative of slowed atrial conduction, as well as increased inducible AF burden and sustained AF, compared with wild type, and these abnormalities were prevented by 2-hydroxybenzylamine. Both reactive oxygen species and isolevuglandin protein adducts were elevated in Pitx2+/- atria with reduced expression of reactive oxygen species-protective genes. High-resolution respirometry demonstrated impaired mitochondrial function in Pitx2+/- atria, with disruption of mitochondrial integrity and cell-cell junctions with connexin lateralization, as well as decreased mitochondrial biogenesis gene expression. Proarrhythmic ionic current remodeling in Pitx2+/- atrial myocytes included elevated resting membrane potential, abbreviated action potential duration, and reduced maximum phase 0 upstroke velocity compared with wild type. Most of these abnormalities were ameliorated or prevented by 2-hydroxybenzylamine.CONCLUSIONS:These results demonstrate a critical role for lipid dicarbonyl mediators of oxidative stress in the proarrhythmic remodeling and AF susceptibility that occurs with Pitx2 deficiency, implying the possibility of genotype-specific therapy to prevent AF.

Exertional dyspnea has been documented in U.S. military personnel after deployment to Iraq and Afghanistan. We studied whether continued exertional dyspnea in this patient population is associated with pulmonary vascular disease (PVD). We performed detailed histomorphometry of pulmonary vasculature in 52 Veterans with biopsy-proven post-deployment respiratory syndrome (PDRS) and then recruited five of these same Veterans with continued exertional dyspnea to undergo a follow-up clinical evaluation, including symptom questionnaire, pulmonary function testing, surface echocardiography, and right heart catheterization (RHC). Morphometric evaluation of pulmonary arteries showed significantly increased intima and media thicknesses, along with collagen deposition (fibrosis), in Veterans with PDRS compared to non-diseased (ND) controls. In addition, pulmonary veins in PDRS showed increased intima and adventitia thicknesses with prominent collagen deposition compared to controls. Of the five Veterans involved in our clinical follow-up study, three had borderline or overt right ventricle (RV) enlargement by echocardiography and evidence of pulmonary hypertension (PH) on RHC. Together, our studies suggest that PVD with predominant venular fibrosis is common in PDRS and development of pulmonary hypertension may explain exertional dyspnea and exercise limitation in some Veterans with PDRS.

BACKGROUND: Diagnostic yield and accuracy endpoints have been used inconsistently in the evaluation of advanced diagnostic bronchoscopy devices and techniques, limiting betweenstudy comparisons. In addition, diagnostic accuracy can be adjudicated only after prolonged clinical follow-up, which delays reporting on the performance of novel devices. RESEARCH QUESTION: Will a conservative diagnostic yield de fi nition result in few falsenegative initial results to closely approximate diagnostic accuracy and represent a useful outcome for future studies of diagnostic utility? METHODS: Commonly used de fi nitions of diagnostic yield were applied to a prospective data set of consecutive peripheral pulmonary lesions sampled by navigational bronchoscopy from 2017 to 2019. All consider malignancy to be diagnostic but differ in their classi fi cation of nonmalignant biopsy fi ndings, which were subcategorized as speci fi c benign, nonspeci fi c benign, or normal lung. Diagnostic yield calculations were also compared with diagnostic accuracy, de fi ned as the proportion of biopsy specimens deemed diagnostic by each de fi ni- tion that were con fi rmed accurate through 2 years of follow-up. RESULTS: A total of 450 biopsy specimens of lesions were analyzed. The prevalence of malignancy was 60.9% (274 of 450). On initial bronchoscopy pathology, there were 227 malignant diagnoses (50.4%), with a single false positive (0.4%). Among 104 biopsy specimens with speci fi c benign fi ndings, only two were false negative for malignancy (1.9%). There were 119 nonspeci fi c benign biopsy specimens, with 46 false negatives for malignancy (38.7%). The discrepancy between diagnostic yield and accuracy was 0.7% for the conservative de fi - nition, which only considered malignant or speci fi c benign fi ndings as diagnostic. INTERPRETATION: A conservative diagnostic yield de fi nition excluding nonspeci fi c benign diagnoses closely approximated diagnostic accuracy through 2 years ' follow-up, with a less than 1% discrepancy. Using this conservative yield de fi nition may allow for dissemination of reliable diagnostic utility data without protracted delays needed for follow-up data in this era of rapid technological change in advanced diagnostic bronchoscopy.

In a previous article, we focused on dissertation research related to rigor and the central role of rigor in Ph.D. dissertation research (Goodman et al., 2020). In this article, we focus on representations of dissertation rigor as it relates to the major components of the dissertation chapters (nature of the study, literature review, methodology, results, and discussion). We address the critical and central importance of good writing in dissertations, identify indicators of rigorous research, and discuss implications for nursing faculty, doctoral students, and the nursing profession.

Healthcare in the U.S. is the most expensive in the world, presenting a complex environment that demands nurse leaders possess consummate business skills. This article chronicles the 30-year journey of incorporating business acumen into nursing education, detailing the resistance and gradual acceptance within the nursing profession. Despite significant progress, a notable gap remains in financial literacy and business proficiency among nurse leaders, often limiting their engagement in financial management roles. The discussion extends to the challenges and opportunities the evolving healthcare landscape presents, where business and financial competencies are increasingly essential for effective leadership. This article aims to underscore the critical need for nurse leaders to be equipped with advanced business skills to successfully navigate the complex healthcare environment. It also emphasizes the pivotal role of nursing academia in integrating business education into program curricula. The Doctor of Nursing Practice/Master of Business Administration dual degree is presented as an innovative educational pathway designed to bridge this gap by providing comprehensive business knowledge and skills. With this degree, the next generation of nurse executives will be well-prepared to become 'guardians at the gate' in the complex world of healthcare, driving meaningful change and improving healthcare outcomes.

Background Cardiac mucinous deposits are a rare entity only previously described in the setting of scleromyxedema, a disorder characterized by cutaneous and systemic mucin deposits, fibroblastic proliferation, and monoclonal gammopathies.Case summary A 41-year-old woman was transferred to our hospital after a month-long hospitalization with worsening cardiogenic shock requiring ionotropic support. Cardiac magnetic resonance imaging revealed a left ventricular ejection fraction of 23%, prior right coronary artery infarct, full-thickness late gadolinium enhancement in the left ventricle basilar wall, global abnormal parametric mapping parameters of both native T1, T2, and extracellular volume, and severe biventricular dysfunction concerning for infiltrative cardiomyopathy. Endomyocardial biopsy demonstrated heavy deposits of interstitial mucin, confirmed by electron microscopy; a Congo red stain was negative for amyloid. She was treated with an aggressive decongestive strategy, oral guideline-directed medical therapy, and intravenous immunoglobulin (IVIg); she was discharged home off inotropic support. Subsequently, she had three additional hospitalizations for heart failure exacerbation in a span of 6 months, and her overall prognosis remains guarded.Discussion We report a first known case of isolated cardiac myxedematosus associated with a severe systolic and diastolic cardiomyopathy. Our patient did not have any clinical evidence of systemic scleromyxedema or paraproteinemia, both of which have been reported in association with cardiac mucin deposits. Mucinosus has been described in patients with systemic lupus erythematous; however, cardiac deposits have not been reported. While IVIg has been used as a treatment in previously reported cases of cardiac scleromyxedema, its clinical benefit remains unclear in isolated cardiac myxedematosus.

BackgroundPeripheral pulmonary lesions (PPL) are common, with more than 1.6 million PPLs incidentally identified in the United States annually. Navigational bronchoscopy (NB) is a cornerstone of the diagnostic evaluation of PPLs. Intraprocedural rapid on-site evaluation (ROSE) of biopsies obtained during NB is widely used, but the data for its utility are contradictory. The cost-effectiveness of ROSE has yet to be established and as such, ROSE currently has variable implementation between institutions and is not adequately reimbursed by payors.Research QuestionIs ROSE cost-effective during NB for PPL from a third-party payor perspective?Study Design and MethodsA cost-effectiveness model was constructed comparing NB for PPL with versus without ROSE from a third-party payor perspective. The base case is a 60-year-old operative candidate with a 2 cm pulmonary nodule without radiographic mediastinal or hilar lymphadenopathy referred for NB. Cost per quality adjusted life-year gained was the primary outcome. Inputs for the model were estimated from published literature. One-way deterministic sensitivity analyses were conducted on all parameters. Probabilistic sensitivity analysis was performed.ResultsThe use of ROSE resulted in a gain of 0.01 quality-adjusted life years and cost an additional $466. At a willingness to pay (WTP) threshold of $100,000/life-year, ROSE was cost-effective with an incremental cost effectiveness ratio (ICER) of $44,465.88. Sensitivity analyses on the sensitivity of NB with and without ROSE show that ROSE must increase the diagnostic sensitivity of the procedure by 3% to become cost-effective.InterpretationThe use of ROSE during navigational bronchoscopy for PPL is cost-effective for third-party payors at a WTP threshold of $100,000/life year and should be reimbursed at a higher rate. The cost-effectiveness of ROSE hinges on the additional diagnostic sensitivity gained by using ROSE.

HomeCirculation: Heart FailureVol. 17, No. 1Rare Etiology of Cardiogenic Shock in Pregnancy No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFull TextRare Etiology of Cardiogenic Shock in Pregnancy Lyana Labrada, Lindsay Panah, Joyce Johnson, Kaitlyn Brennan, Chetan Pasrija, Matthew Grace, Jonathan Menachem and Aniket S. Rali Lyana LabradaLyana Labrada Division of Cardiovascular Diseases (L.L., L.P., J.M., A.S.R.), Vanderbilt University Medical Center, Nashville, TN. , Lindsay PanahLindsay Panah Division of Cardiovascular Diseases (L.L., L.P., J.M., A.S.R.), Vanderbilt University Medical Center, Nashville, TN. , Joyce JohnsonJoyce Johnson https://orcid.org/0000-0002-3680-4372 Department of Pathology (J.J.), Vanderbilt University Medical Center, Nashville, TN. , Kaitlyn BrennanKaitlyn Brennan https://orcid.org/0000-0002-6449-6418 Department of Anesthesiology (K.B.), Vanderbilt University Medical Center, Nashville, TN. , Chetan PasrijaChetan Pasrija https://orcid.org/0000-0003-4487-4343 Department of Cardiac Surgery (C.P.), Vanderbilt University Medical Center, Nashville, TN. , Matthew GraceMatthew Grace https://orcid.org/0000-0003-3654-0677 Department of Obstetrics and Gynecology (M.G.), Vanderbilt University Medical Center, Nashville, TN. , Jonathan MenachemJonathan Menachem Division of Cardiovascular Diseases (L.L., L.P., J.M., A.S.R.), Vanderbilt University Medical Center, Nashville, TN. and Aniket S. RaliAniket S. Rali Correspondence to: Aniket S. Rali, MD, Division of Cardiovascular Diseases, Vanderbilt University Medical Center, 1215 21st Ave S, Ste 5209, Nashville, TN 37232. Email E-mail Address: [email protected] Division of Cardiovascular Diseases (L.L., L.P., J.M., A.S.R.), Vanderbilt University Medical Center, Nashville, TN. Originally published6 Dec 2023https://doi.org/10.1161/CIRCHEARTFAILURE.123.011006Circulation: Heart Failure. 2024;17FootnotesFor Sources of Funding and Disclosures, see page 79.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCHEARTFAILURE.123.011006.Correspondence to: Aniket S. Rali, MD, Division of Cardiovascular Diseases, Vanderbilt University Medical Center, 1215 21st Ave S, Ste 5209, Nashville, TN 37232. Email aniket.rali@vumc.orgREFERENCES1. Bang V, Ganatra S, Shah SP, Dani SS, Neilan TG, Thavendiranathan P, Resnic FS, Piemonte TC, Barac A, Patel R, et al. Management of patients with giant cell myocarditis: JACC review topic of the week.J Am Coll Cardiol. 2021; 77:1122–1134. doi: 10.1016/j.jacc.2020.11.074CrossrefMedlineGoogle Scholar2. Rosenstein ED, Zucker MJ, Kramer N. Giant cell myocarditis: most fatal of autoimmune diseases.Semin Arthritis Rheum. 2000; 30:1–16. doi: 10.1053/sarh.2000.8367CrossrefMedlineGoogle Scholar3. Kandolin R, Lehtonen J, Salmenkivi K, Räisänen-Sokolowski A, Lommi J, Kupari M. Diagnosis, treatment, and outcome of giant-cell myocarditis in the era of combined immunosuppression.Circ Heart Fail. 2013; 6:15–22. doi: 10.1161/CIRCHEARTFAILURE.112.969261LinkGoogle Scholar4. Veronese G, Nonini S, Cannata A, Aresta F, Olivieri G, Montrasio E, De Caria D, Perna E, Calini A, Bottiroli M, et al. Fulminant lymphocytic myocarditis during pregnancy treated with temporary mechanical circulatory supports and aggressive immunosuppression.Circ Heart Fail. 2022; 15:e009810. doi: 10.1161/CIRCHEARTFAILURE.122.009810LinkGoogle Scholar5. Van Haelst PL, Van Rossem M, Valentijn RM, Beijer GJ. Giant cell myocarditis: a fatal cause of dyspnea in pregnancy.Eur J Obstetr Gynecol Reproduc Biol. 2001; 100:105–107. doi: 10.1016/s0301-2115(01)00449-3CrossrefMedlineGoogle Scholar6. Merz WM, Fischer-Betz R, Hellwig K, Lamprecht G, Gembruch U. Pregnancy and autoimmune disease: diseases of the nervous system, connective tissue, and the bowel.Dtsch Arztebl Int. 2022; 119:145–156. doi: 10.3238/arztebl.m2021.0353CrossrefMedlineGoogle Scholar7. Liu S, Zheng L, Shen L, Wu L, Yao Y. Clinical identification and characteristic analysis of giant cell myocarditis in 12 cases.Front Cardiovasc Med. 2021;649094. doi: 10.3389/fcvm.2021.649094CrossrefMedlineGoogle Scholar8. Shields RC, Tazelaar HD, Berry GJ, Cooper LT. The role of right ventricular endomyocardial biopsy for idiopathic giant cell myocarditis.J Card Fail. 2002; 8:74–78. doi: 10.1054/jcaf.2002.32196CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails January 2024Vol 17, Issue 1 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.123.011006PMID: 38054278 Originally publishedDecember 6, 2023 Keywordsblood pressureheart failurehemodynamicspericardial effusionpregnancyPDF download Advertisement SubjectsHeart Failure

Background:Lung nodule incidence is increasing. Many nodules require biopsy to discriminate between benign and malignant etiologies. The gold-standard for minimally invasive biopsy, computed tomography-guided transthoracic needle biopsy (CT-TTNB), has never been directly compared to navigational bronchoscopy, a modality which has recently seen rapid technological innovation and is associated with improving diagnostic yield and lower complication rate. Current estimates of the diagnostic utility of both modalities are based largely on non-comparative data with significant risk for selection, referral, and publication biases. Methods:The VERITAS trial (na V igation E ndoscopy to R each Indeterminate lung nodules versus T ransthoracic needle A spiration, a randomized controlled S tudy) is a multicenter, 1:1 randomized, parallel-group trial designed to ascertain whether electromagnetic navigational bronchoscopy with integrated digital tomosynthesis is noninferior to CT-TTNB for the diagnosis of peripheral lung nodules 10-30 mm in diameter with pre-test probability of malignancy of at least 10%. The primary endpoint is diagnostic accuracy through 12 months follow-up. Secondary endpoints include diagnostic yield, complication rate, procedure duration, need for additional invasive diagnostic procedures, and radiation exposure. Discussion:The results of this rigorously designed trial will provide high-quality data regarding the management of lung nodules, a common clinical entity which often represents the earliest and most treatable stage of lung cancer. Several design challenges are described. Notably, all nodules are centrally reviewed by an independent interventional pulmonology and radiology adjudication panel relying on pre-specified exclusions to ensure enrolled nodules are amenable to sampling by both modalities while simultaneously protecting against selection bias favoring either modality. Conservative diagnostic yield and accuracy definitions with pre-specified criteria for what non-malignant findings may be considered diagnostic were chosen to avoid inflation of estimates of diagnostic utility. Trial registration:ClinicalTrials.gov NCT04250194.

Although profibrotic cytokines, such as IL-17A and TGF-β1, have been implicated in the pathogenesis of interstitial lung disease (ILD), the interactions between gut dysbiosis, gonadotrophic hormones and molecular mediators of profibrotic cytokine expression, such as the phosphorylation of STAT3, have not been defined. Here, through chromatin immunoprecipitation sequencing (ChIP-seq) analysis of primary human CD4+ T cells, we show that regions within the STAT3 locus are significantly enriched for binding by the transcription factor estrogen receptor alpha (ERa). Using the murine model of bleomycin-induced pulmonary fibrosis, we found significantly increased regulatory T cells compared to Th17 cells in the female lung. The genetic absence of ESR1 or ovariectomy in mice significantly increased pSTAT3 and IL-17A expression in pulmonary CD4+ T cells, which was reduced after the repletion of female hormones. Remarkably, there was no significant reduction in lung fibrosis under either condition, suggesting that factors outside of ovarian hormones also contribute. An assessment of lung fibrosis among menstruating females in different rearing environments revealed that environments favoring gut dysbiosis augment fibrosis. Furthermore, hormone repletion following ovariectomy further augmented lung fibrosis, suggesting pathologic interactions between gonadal hormones and gut microbiota in relation to lung fibrosis severity. An analysis of female sarcoidosis patients revealed a significant reduction in pSTAT3 and IL-17A levels and a concomitant increase in TGF-β1 levels in CD4+ T cells compared to male sarcoidosis patients. These studies reveal that estrogen is profibrotic in females and that gut dysbiosis in menstruating females augments lung fibrosis severity, supporting a critical interaction between gonadal hormones and gut flora in lung fibrosis pathogenesis.

Background: Increased frequency of exertional dyspnea has been documented in U.S. military personnel after deployment to Southwest Asia and Afghanistan. We studied whether continued exertional dyspnea in this patient population is associated with pulmonary vascular disease (PVD). Methods: We recruited five Iraq and Afghanistan Veterans with post-deployment respiratory syndrome (PDRS) and continued exertional dyspnea to undergo a detailed clinical evaluation including symptom questionnaire, pulmonary function testing (PFT), surface echocardiography, and right heart catheterization (RHC) with exercise. We then performed detailed histomorphometry of blood vasculature in 52 Veterans with PDRS, 13 patients with advanced idiopathic pulmonary arterial hypertension (PAH) and 15 non-diseased (ND) control subjects. Results: All five Veterans involved in clinical follow-up study had a continued dyspnea at exertion. On transthoracic echocardiography, we identified borderline or overt RV enlargement in three out of five Veterans. Right ventricle outflow tract (RVOT) acceleration time, a well-established surrogate measure of pulmonary pressure, was mildly reduced in three out of five Veterans. Of the five Veterans with PDRS who underwent RHC at exercise, we found that three had evidence of post-capillary PH at rest and one had PH at exercise. Morphometric evaluation of lung biopsy samples showed mild/moderate increase of fractional thicknesses of intima and media, and significant fibrosis of adventitia in pulmonary arteries in Veterans with PDRS compared to ND controls and PAH patients. Veterans with PDRS did not display plexiform or dilation/angiomatoid lesions, specific for PAH. Pulmonary veins showed similar levels of intima and adventitia fractional thickening in Veterans with PDRS and PAH patients compared to ND controls. In Veterans, IA veins were characterized by marked fibrous intima and adventitia thickening, usually with increased thickening and formation of multiple layers of elastic laminae, but without features of luminal occlusion, muscular hyperplasia or dilation/angiomatoid lesions seen in pulmonary veno-occlusive disease or chronic thromboembolic PH. Conclusions: Our studies suggest that vasculopathy and PVD may explain exertional dyspnea and exercise limitation in some Veterans with PDRS. Evaluation for PVD should be considered in Iraq and Afghanistan Veterans with unexplained dyspnea.

Background and objectives: In the last two decades, enrollment in doctoral programs in nursing has increased dramatically. Completion of these advanced degrees is being hampered by prevailing weaknesses in a key competency that is critical to graduate nurses’ ability to successfully complete their graduate program: academic writing proficiency. These weaknesses endanger the success of graduate nursing programs and the nursing profession’s ability to meet its primary professional obligation: advancement of scientific knowledge through professional publications, policy briefs, business cases, and innovative, evidence-based projects. This research aimed to determine the national nursing faculty’s perceptions of graduate nurses’ writing skills and techniques used to improve their writing proficiency.Methods: The authors employed a descriptive online survey design to examine perspectives on the state of writing proficiency in graduate nursing programs in a nationwide sample of 2,234 faculty members. Statistical analyses included the calculation of percentages for all categorical variables and means, standard deviations, and ranges for continuous variables.Results: The survey results describe a myriad of pervasive weaknesses in graduate nurses’ writing and the limited effectiveness of techniques used to improve writing skills.Conclusions: The article concludes with an association between writing problems in nursing and the concept of active inertia in academia and suggestions for advancing this growing concern to the top of nursing’s agenda and training nursing faculty.

Background: Primary lung cancer is the most common cause of cancer-related mortality in the United States (US). Approximately 90% of lung cancers are associated with smoking and the use of other tobacco products. Based on histology, lung cancers are divided into small-cell lung carcinomas (SCLCs) and non-small-cell lung carcinomas (NSCLCs). Most SCLCs are of the pure subtype, while the rare combined SCLCs contain elements of both small-cell and non-small-cell morphologies. This study sought to evaluate the demographics, clinical factors, molecular abnormalities, treatment approaches, and survival outcomes with combined SCLC and NSCLCs. Materials and Methods: Data on 2126 combined SCLC patients was extracted from the Surveillance Epidemiology and End Result (SEER) database from 2000 to 2018. Data extracted for analyses included age, sex, race, tumor size, tumor location, metastasis status, stage at diagnosis, treatment received, and treatment outcomes. Multivariate analysis was performed using Statistical Product and Service Solutions (SPSS) software. Results: The patients had a median age of 68 years; 43.9% of the patients were female and 56.1% were male; 84.5% were White and 11.7% were African Americans. The majority of patients had a poorly differentiated disease at 29.6%; 17% were undifferentiated, 3.2% were moderately differentiated, and 0.8% were well differentiated. Chemotherapy was the most common treatment modality (45.3%); 17% underwent surgery only, 10.3% underwent surgery followed by adjuvant chemotherapy, and 10% underwent radiation after surgery. Five-year cancer-specific survival was 15.2% with surgery alone, and combined surgery and chemotherapy provided the highest percentages (38.3% and 34.7%, respectively). Females had significantly higher 1- and 5-year cancer-specific survival rates compared to males (59.3% and 29.9% vs. 48.0% and 23.7, respectively; p < 0.001). Well-differentiated tumors had significantly higher survival compared to other gradings (p < 0.001). Survival decreased as tumor staging moved distally from localized to regional to distant (p < 0.001). Metastasis to bone, liver, brain, and lung significantly decreased survival in comparison to patients who did not have any metastasis (p < 0.001). Females had significantly shorter survival compared to their counterparts when metastasis was to the bone, brain, or liver (p < 0.001). Multivariate analysis identified male sex (Hazard Ratio (HR) = 1.2), undifferentiated grade (HR = 1.9), regional extent of disease (HR = 1.7), distant extent of disease (HR = 3.7), and metastasis to liver (HR = 3.5) as variables associated with worse survival. Conclusion: Combined SCLC is overall very rare. However, the frequency of presentation with combined SCLC is on the rise, in part due to improvements in diagnostic techniques. Despite advances in therapies, treating combined SCLC is challenging, and novel therapies are not utilized, owing to low rates of targetable mutations. Combined SCLC has higher survival rates if well differentiated.

Since 2011, enrollment in Doctor of Nursing Practice (DNP) and Doctor of Philosophy (Ph.D.) graduate nursing programs increased by almost 300%, suggesting that nursing had entered its “golden age.” This steep-growth trajectory reflects the concomitant growth in the number of doctoral programs, today exceeding 435 for the combined DNP and Ph.D. degrees. Unfortunately, the recent progress in advancing nurses in academic programs is hampered by a weakness in a competency crucial for nurses to complete their rigorous academic programs and disseminate research findings or evidence-based practice project interventions: academic writing proficiency. Since nursing curricula at the undergraduate level place lesser emphasis on the humanities, nursing students lack training in the liberal arts compendium of logic, grammar, and rhetoric necessary for effective and articulate communication and dissemination of knowledge in the field of nursing. Data generated from a recent national survey offers new perspectives on the pervasive problem of poor scholarly writing evidenced by students in graduate nursing programs: 97% of graduate papers contain grammatical errors, and only 13% of students demonstrate higher-order skills. While 81% of graduate program faculty ranked their own writing ability as “exceptional” or “highly proficient,” graduate faculty noted that 97% of the time, student papers evidenced numerous grammatical errors, such as flawed sentence structure, run-on sentences, punctuation errors, and ambiguous word choice. These data suggest that graduate nursing programs must pursue avenues to address student writing shortfalls. The authors opine that the absence of action suggests that graduate nursing programs may be in a dilemma that parallels the metaphor and urban legend of the boiled frog, wherein acceptance of an unacceptable change occurs gradually through minor, unimportant, and unnoticed increments. Aimed at addressing this dilemma, the authors discuss the potential value of offering a customized writing course to refresh and improve students’ basic writing mechanics. A sample curriculum focuses on critical thinking, clarity, and logical flow. Nursing academicians must acknowledge the drift to low writing performance in their students, advance proficiency in scholarly writing to the top of the graduate nursing education’s agenda, and prepare nurses to achieve in nursing’s “golden age.”

To the Editor On June 24, 2022, the US Supreme Court decided in a landmark ruling in Dobbs v Jackson Women’s Health to overturn the 1973 case of Roe v Wade,1 which had previously standardized how states could regulate abortion and protected abortion under the constitutional right of privacy. The US Supreme Court argued in Dobbs v Jackson Women’s Health that the US Constitution does not, in fact, guarantee a right to abortion and returned the ability to define abortion rights and determine abortion restrictions to individual states. This policy change has resulted in a complex cascade of confusing and conflicting legislation regarding abortion and obstetric care for patients and providers alike. The scope of proposed restrictions has been vast, ranging from restriction of elective abortion to delay of care for ectopic pregnancies and other nonviable circumstances in which the life of the pregnant person may be jeopardized. The extent of the damage this policy will have on the health care of patients capable of pregnancy remains to be seen, but many individuals in the United States are in the process of losing critical elements of obstetrical care, particularly in Black, Hispanic, and low-income communities.2 One must look no further than to states with “trigger laws,” which were designed to take effect as soon as possible following the court’s decision, with at least 8 states banning abortion the day of the ruling.3 Notably, although most states include exceptions to protect the life of the pregnant individual, this language is complicated and ambiguous,3 already leading to instances of dangerously delayed care. To see the deadly impact of restrictive abortion laws, one can look at the obstetrical outcomes in Poland. Although Polish law technically allows exceptions when the life of the mother is endangered, several deaths resulting from refusal to provide medical intervention for nonviable pregnancies have been recorded.4,5 Given the United States’ high maternal mortality rate, forced continuance of pregnancy risks increased pregnancy-associated deaths, whether from complications directly related to the pregnancy or from intimate partner violence.6,7