Sepsis Program Activities in Acute Care Hospitals - National Healthcare Safety Network, United States, 2022.

Sepsis, life-threatening organ dysfunction secondary to infection, contributes to at least 1.7 million adult hospitalizations and at least 350,000 deaths annually in the United States. Sepsis care is complex, requiring the coordination of multiple hospital departments and disciplines. Sepsis programs can coordinate these efforts to optimize patient outcomes. The 2022 National Healthcare Safety Network (NHSN) annual survey evaluated the prevalence and characteristics of sepsis programs in acute care hospitals. Among 5,221 hospitals, 3,787 (73%) reported having a committee that monitors and reviews sepsis care. Prevalence of these committees varied by hospital size, ranging from 53% among hospitals with 0-25 beds to 95% among hospitals with >500 beds. Fifty-five percent of all hospitals provided dedicated time (including assigned protected time or job description requirements) for leaders of these committees to manage a program and conduct daily activities, and 55% of committees reported involvement with antibiotic stewardship programs. These data highlight opportunities, particularly in smaller hospitals, to improve the care and outcomes of patients with sepsis in the United States by ensuring that all hospitals have sepsis programs with protected time for program leaders, engagement of medical specialists, and integration with antimicrobial stewardship programs. CDC's Hospital Sepsis Program Core Elements provides a guide to assist hospitals in developing and implementing effective sepsis programs that complement and facilitate the implementation of existing clinical guidelines and improve patient care. Future NHSN annual surveys will monitor uptake of these sepsis core elements.

Factor Analysis on Multiple Auditory Processing Assessment-2 and Listening in Spatialized Noise-Sentences Test in Children.

Introduction There is need for greater understanding of tests used in assessing all aspects of auditory processing disorder (APD). This is important so that specific deficits can be identified and later remediated with the smallest possible test battery. The American Speech-Language-Hearing Association (ASHA) recommends five areas/domains for behavioral assessment: (a) temporal, (b) binaural (dichotic) separation/integration, (c) monaural low redundancy, (d) binaural interaction/localization/lateralization, and (e) auditory discrimination. Multiple-factor studies support the first three domains, which are most often used for APD assessment and which can be measured in a test battery normed within the United States (Multiple Auditory Processing Assessment-2 [MAPA-2]). This study was designed to determine if factored results from children would clarify whether a behavioral test (Listening in Spatialized Noise-Sentences Test [LiSN-S]) would factor within one of the first three domains or be separate, possibly within the fourth domain, binaural interaction. Method Fifty-one 8- and 9-year-olds with normal development and normal otoscopy and hearing responses bilaterally from 500 to 4000 Hz at 20 dB HL were recruited. Two sets of APD tests were administered: MAPA-2 and LiSN-S. Results Results verified the expected three-factor structure for MAPA-2. LiSN-S did not factor within one of those three, suggesting that some processes involved in the LiSN-S tasks require interactions between the two ears different from those involved in dichotic perception and thus better belong in the ASHA binaural interaction/lateralization domain. Conclusions Auditory processing abilities are sufficiently independent of each other that test batteries spanning the first three ASHA domains are not sensitive to at least some abilities in the fourth domain. This additional factor evidence is helpful. Future research should examine the utility of measuring additional factors within APD in order to achieve the most efficient and comprehensive test battery.

Validity of the Multiple Auditory Processing Assessment-2: A Test of Auditory Processing Disorder.

Purpose A normative study using the Multiple Auditory Processing Assessment-2 (MAPA-2; Schow et al., 2018) was recently completed. With access to these data, the authors extend that work and support a definite construct for auditory processing disorder (APD). The goal here is to examine MAPA-2 reliability and validity (construct, content, and concurrent). Evidence for the APD construct is further buttressed by measures of sensitivity and specificity. Results of MAPA-2 testing on children diagnosed with learning disability (LD), attention-deficit/hyperactivity disorder (ADHD), and specific language impairment (SLI) are included. Method Normative data (previously published as the MAPA-2) allowing derivation of these findings included a representative sample of 748 children (53% girls) ages 7-14 years tested by 54 speech-language pathologists and audiologists in 27 U.S. states. The authors examined diagnostic accuracy based on the American Speech-Language-Hearing Association (2005) criteria (index test) for confirmed cases of APD. The index was also used to identify listening problems for three other diagnostic categories (LD, ADHD, and SLI). Validated questionnaire responses from parents and school personnel allowed incorporation of functional measures widely supported in APD diagnosis but unavailable with other normative and sensitivity/specificity studies. Results Reliability and validity were both satisfactory, and diagnostic accuracy for an APD group of 18 (28% female) compared to the remaining typical group of 625 yielded 89% sensitivity and 82% specificity. The remaining three groups (LD, ADHD, and SLI), where comorbidity was expected to be about 50%, had APD-type listening problems with a prevalence ranging from 52% to 65%. Conclusions Current results provide important evidence for the construct of APD. The MAPA-2 can be administered by an audiologist or speech-language pathologist. A similar diagnostic protocol in Australia yielded positive therapeutic gains. Further study is encouraged to determine if the present positive findings will be found in future research.

A carpal ligament substitute part II: polyester suture for scapho-lunate and triqueto-lunate ligament reconstruction.

Carpal ligaments are commonly injured and may lead to pain and disability. These ligaments are very difficult to repair, and the results are unpredictable; as a result, treatment options abound. A novel approach is presented here using a polyester suture, aiming to substitute these ligaments' function, rather than to repair them.

Appalachian women: health beliefs, self-care, and basic conditioning factors.

The purposes of this study were to: (a) describe the health beliefs and self-care of Appalachian women; and (b) describe the relationships among health beliefs, self-care, and the basic conditioning factors of Appalachian women. Orem's SCDNT was used as the theory for this study. This study used qualitative and quantitative methodologies. The study participants included 129 Appalachian women. Health beliefs and self-care were described. Significant correlations were found between components of the basic conditioning factors and definition of health beliefs and self-care. The outcomes from this research study support that Appalachian women do participate in self-care in promoting their health.

Meeting the health care needs of medically underserved, uninsured, & underinsured Appalachians.

There is the need for critical changes in the United States health care system to meet the rising costs of health care and the massive number of people without health insurance. The Berea Health Ministry Rural Health Clinic (BHMRHC) is a nurse-managed, rural primary health care clinic that was designed to respond to the health care needs of the underserved, uninsured, and underinsured populations in a designated nine county area of Appalachian Kentucky. The process used in the development and implementation of BHMRHC is described as a model to assist in the future development of similar clinics.

Epineurectomy for thoracic outlet syndrome.

The authors' approach to patients with TOS starts with a thorough evaluation, including a detailed history, physical examination, electromyography, and radiographs. Once the work-up is complete a treatment plan is formulated with the patient. All diagnoses are prioritized, together with various options for treatment of each. Therapy is initiated when appropriate and a surgical plan addresses the worst nerve entrapments sequentially. The authors' favored procedure for TOS release is an anterior scalenectomy with epineurectomy, with decompression of any structures impinging on the brachial plexus. The authors encourage patients to attend therapy for approximately 3 months after surgery, and to follow a home program of rehabilitation to maximize their gains and decrease the chance of recurrence.