A validation of the Oswestry Spinal Risk Index.

PURPOSE: The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC). METHODS: We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper. RESULTS: Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004). CONCLUSIONS: Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSCC.

Characteristics, management and outcome of a large necrotising otitis externa case series: need for standardised case definition.

BACKGROUND: Necrotising otitis externa is a severe ear infection for which there are no established diagnostic or treatment guidelines. METHOD: This study described clinical characteristics, management and outcomes for patients managed as necrotising otitis externa cases at a UK tertiary referral centre. RESULTS: A total of 58 (63 per cent) patients were classified as definite necrotising otitis externa cases, 31 (34 per cent) as probable cases and 3 (3 per cent) as possible cases. Median duration of intravenous and oral antimicrobial therapy was 6.0 weeks (0.49-44.9 weeks). Six per cent of patients relapsed a median of 16.4 weeks (interquartile range, 23-121) after stopping antimicrobials. Twenty-eight per cent of cases had complex disease. These patients were older (p = 0.042), had a longer duration of symptoms prior to imaging (p < 0.0001) and higher C-reactive protein at diagnosis (p = 0.005). Despite longer courses of intravenous antimicrobials (23 vs 14 days; p = 0.032), complex cases were more likely to relapse (p = 0.016). CONCLUSION: A standardised case-definition of necrotising otitis externa is needed to optimise diagnosis, management and research.

COVID-19 presenting with spontaneous massive pneumomediastinum in a three-month-old child.

A three-month-old child presented to our district general hospital with acute respiratory distress. He was found to have massive spontaneous pneumomediastinum and extensive surgical emphysema overlying the neck. Tracheal intubation using the GlideScope® was difficult, and the patient's trachea was ultimately intubated with a direct laryngoscope. Computed tomography revealed bilateral lung consolidation and reverse transcriptase-polymerase chain reaction swab was positive for SARS-CoV-2. There was no other precipitating factor to explain the presence of pneumomediastinum. The patient was treated with pleural and mediastinal drains, required five days of mechanical ventilation on a paediatric intensive care unit and subsequently made a full recovery. We outline our initial differential diagnosis, airway management plan, and propose a mechanism for the development of spontaneous pneumomediastinum in this case. We suggest that clinicians should consider pneumomediastinum as a potential cause of surgical emphysema, particularly in the context of COVID-19, even in infants. To our knowledge, this is the first reported case of COVID-19 in this age group with spontaneous pneumomediastinum as the presenting feature.

Symptomatic, steroid-induced, multifocal diaphyseal osteonecrosis in a patient with multiple sclerosis.

There is a well-established link between the development of osteonecrosis and steroid administration. Diaphyseal osteonecrosis is rare and, when present, frequently asymptomatic and detected radiologically. We present a case of symptomatic, multifocal, diaphyseal osteonecrosis in a woman receiving pulsed corticosteroids for symptom control of multiple sclerosis (MS). She was investigated for knee pain, which could have been attributed to her primary disease, and magnetic resonance imaging (MRI) revealed bone infarcts within the femur, tibia and talus. She underwent successful intra-medullary reaming to the diaphyseal infarcts. This case highlights the importance of investigating musculoskeletal pain in patients with MS, receiving corticosteroids.

Architectural features and perceptions of community residences for people with mental retardation.

Architects, group home administrators, people with mental retardation, family members of people with mental retardation, and college undergraduates substantially agreed regarding the rated homelikeness of slides of interiors of 20 community residences for people with mental retardation ranging from institutional to homey, mean r = .87. Clusters of physical features identified using an architectural inventory were found to be associated with homelikeness ratings. Adjectives applied to rooms with these features were determined using a Q-sort method. Two factors were identified from Q-sort correlations: Homelikeness-Institutionality and Spatial Organization as well as a third variable, privacy.

Interdependence of architectural features and program variables in community residences for people with mental retardation.

In an earlier study, we found that architects, group home administrators, people with mental retardation, family members of people with mental retardation, and college undergraduates rated the homelikeness of slides of community residences for people with mental retardation similarly. In addition, clusters of physical features were identified that were specifically associated with homelikeness ratings. In the present study, behavior of residents with mental retardation living in those residences was assessed using the Aberrant Behavior Checklist and direct behavioral observations. After statistically controlling for confounding variables, we found that adaptive and maladaptive behavior covaried with homelikeness ratings. In addition, we were able to identify associations between specific architectural features of residential settings and the behavior of residents living in those settings.

Addressing challenges in nursing informatics instruction.

Objectives for the interactive experiences include exposure to a wide variety of computer applications; in-depth experience with at least one application; overcoming computer fear; appreciating the rigid, logical flow of computerized problem-solving; and appreciating the benefits and limitations of computer applications for a variety of purposes. Ultimately, a major purpose of transferring informatics content is related to stimulating students' imagination with respect to the computer's ability to aid their professional endeavors. Robinson (1984) describes the imagination factor: "I think the total potential of computers is only limited by our imagination. It's like giving an artist a palette that has an infinite number of colors, some of them invisible to the naked eye. . . It is a tool for the realization of ideas." Students who have been exposed to the benefits of major categories of computer applications can appreciate computer capabilities with respect to exploring scientific and nursing phenomena, and building databases to store and access information (Newbern, 1985). These students should have enough theoretical and experimental knowledge of computers to become actively involved in making creative, informed decisions about how computers will be applied to nursing in their professional setting. Hardin and Skiba (1982) noted a gap between the powerful information processing capabilities of the computer and its relatively limited use by nursing--a gap which still exists today. Students who have participated in an idea generation course on computer applications can help to bridge this gap, helping nursing to take full advantage of the computer-saturated environments of the future.

Determining cost drivers for pediatric home health services.

A variety of cost constraints threaten the financial viability of home health agencies. Thus, tools must be developed that expand the critical information resources that will be the key ingredient in successfully navigating the challenges in the volatile home health market. Identifying and analyzing the core processes with the pediatric home care team provided a template that could be used with other agency patient populations by producing cost trajectories based on anticipated care requirements and capturing information that could be used for both internal and external benchmarking. The cost drivers of key processes and activities must be known so that they can be controlled and appropriate rates for capitation contracts can be established. Activity-based management uses cost driver analysis, activity analysis and performance analysis, to determine strategies for redirecting the work processes and agency activities to achieve lasting cost reductions.

The impact of information systems on nursing performance and productivity.

Recent technologic developments have expanded the capabilities of information systems to enhance nursing communication, documentation, and clinical decision making. The author discusses the potential of sophisticated information systems to improve nursing performance and productivity and to affect positively clinical outcomes, patient satisfaction, nursing retention, and strategic planning capabilities. Information systems can serve as a remarkable vehicle for efficiently enhancing quality of care in an environment of stringent cost constraints.

Informatics knowledge: the key to maximizing performance and productivity.

Nurse managers face a competitive and complex market-place that demands greater attention to customer satisfaction along with continual improvements in quality and cost-effectiveness. Without information technology, the manager cannot hope to deliver ever greater quality at less cost. The nurse managers' effective promotion and use of computer applications can have enormous impact on the performance and productivity of their health care facilities. This article explores the potential of information technology to maximize clinical and cost outcomes, optimize decision making, and enhance administrative productivity.

Potential effects of decision support systems on the role of the nurse.

Decision support systems, and expert systems in particular, may have profound effects on nursing's role, causing the profession to reexamine the meaning of expertise for nursing and the educational strategies which enhance its development. In addition, expert systems provide support for enhanced scope of practice and greater autonomy, and they present intriguing liability challenges for the profession. Utilization of these sophisticated systems will encourage the trend toward increased information management, and will underscore the importance of nurses' interpersonal communication skills and their qualitative, ethical contributions to clinical decision-making.

Predictors of pain catastrophizing in women with rheumatoid arthritis.

Catastrophizing has been conceptualized as an appraisal, a cognitive distortion, and a coping mechanism in the psychosocial literature. Regardless of its conceptualization, catastrophizing has been associated with negative psychological and physical outcomes in numerous studies, including our intervention study with 90 women with rheumatoid arthritis. Because of catastrophizing's robust relationship with negative outcomes, predictors of catastrophizing as a pain coping behavior were investigated in this sample, using data collected from two points in time before the intervention. Using Lazarus and Folkman's stress and coping theoretical framework to guide the analyses, variables with a proximal relationship to catastrophizing in the framework were examined for significant associations with pain catastrophizing using correlational analyses. Subsequent stepwise regression involving all variables from Time 1 with significant associations resulted in a model that explained 63% of the variance in Time 2 pain catastrophizing scores. The four predictors in this model were dispositional pessimism, passive pain coping, venting (as a pain coping behavior), and arthritis helplessness. Potential clinical implications related to these predictors are also discussed. Knowledge about predictors of catastrophizing may enhance efforts to address this maladaptive pattern through educational and therapeutic approaches.

Predictors of improvement in a cognitive-behavioral intervention for women with rheumatoid arthritis.

In this article we present a secondary analysis of data from a brief cognitive-behavioral intervention for women with rheumatoid arthritis that resulted in significant overall improvements in personal coping resources, pain coping behaviors, psychological well-being, and fatigue. Not every participant, however, improved during the intervention. Establishing predictors of improvement in brief interventions is important to optimize the cost-effective use of these resources. In search of predictors of improvement, we examined demographic and background variables, personal coping resources, pain coping behaviors, and social support. Both linear and quadratic effects were analyzed, comparing baseline measures to both immediate postintervention and 3-month follow-up outcomes using standardized indexes ofpredictors and criteria variables. After removing the effects of baseline scores on the outcomes index, significant predictors of improvement included length of time since diagnosis, personal coping resources, and maladaptive and adaptive pain coping behaviors. Both linear and quadratic effects were found, although this varied as a function of type of predictor.

Effects of a cognitive-behavioral intervention for women with rheumatoid arthritis.

The purpose of this quasi-experimental study was to evaluate the effectiveness of a cognitive-behavioral nursing intervention for women with rheumatoid arthritis (RA). Ninety adult women with RA participated in 1 of 14 nurse-led groups over an 18-month period. Personal coping resources, pain-coping behaviors, psychological well-being, and disease symptomatology were measured at four time periods. There were significant changes on all of the measures of personal coping resources (p < .001) and psychological well-being (p < .05), half of the pain-coping behaviors (p < .05), and one indicator of disease symptomatology (fatigue, p < .05) from pre- to postintervention. Furthermore, the positive changes brought about by the program were maintained over the 3-month follow-up period. The intervention may be adapted to benefit individuals with a variety of stressful medical conditions.

Concept analysis of outcomes for advanced practice nursing.

The importance of accurately measuring health care outcomes is mentioned frequently in the literature. To do so, a common understanding of what constitutes a care delivery outcome is needed. In this article, a concept analysis of outcomes is provided, with identification of potential outcomes relevant to advanced practice.