Evaluating the Efficiency of Survey Collection Methods to Trauma Patients.

BACKGROUND: Traumatic injury survivors often experience negative health consequences, impacting recovery. No studies have assessed the feasibility of evaluating the resiliency of hospitalized trauma patients using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). PURPOSE: The purpose of this study was to determine the most efficient method to collect survey responses on the CD-RISC-10. METHODS: This cross-sectional study used a convenience sample of admitted patients with traumatic injury. Patients were randomized to complete the CD-RISC-10 using pen and paper, tablet, or workstation on wheels. RESULTS: Of the 161 patient surveys, the tablet-based survey took the shortest time to complete (2 minutes, 21 seconds), and the paper survey resulted in the lowest percentage of missed questions (0.5%). Trauma patients reported high levels of resiliency. CONCLUSION: The CD-RISC-10 can be easily administered to trauma patients. Clinicians should balance efficiency and patient preferences when deciding on a survey collection method.

Changes in attitudes toward diabetes in nursing students at diabetes camp.

AIM: The research purpose was to determine whether exposure to residential diabetes camps affects attitudes toward diabetes care and management in nursing students. BACKGROUND: Summer camp for children with type 1 diabetes mellitus (T1D) provides a unique and engaging clinical environment for nursing students to learn about evolving diabetes care and to help children develop diabetes management skills. METHODS: This prospective, pretest/posttest study assessed student nurses' attitudes about diabetes, who attended one of four residential summer camps in the United States, using the Diabetes Attitude Survey 3 (DAS3). The survey was administered before and after clinical experience designed to fulfill experiential curricula requirements from various nursing programs. RESULTS: After attending diabetes camp, nursing students (N = 73) had a positive change in their attitudes regarding the need for special training and the psychosocial impact of diabetes. DISCUSSION: The diabetes camp clinical experience impacted nursing students' attitudes. Diabetes camps are a unique clinical setting that uses learned clinical knowledge and judgment to promote health and prevent disease and disability, supporting the integration of primary care and public health nursing.

Leadership development of nursing professionals: Education and influences of self-efficacy.

BACKGROUND: According to Bandura's theory, understanding the relationship of traits and leader self-efficacy in the various roles of nursing can aid in leader development and the growth of the profession. PURPOSE: The purpose of this study was to explore the perceptions of leader self-efficacy of academic nursing professionals to determine if traits and participation in certain activities was predictive of leader self-efficacy. METHOD: A validated survey tool, the Leader Efficacy Questionnaire (LEQ) was administered to nursing professionals using snowball sampling from publicly available email addresses. FINDINGS: Statistical significance was found between the academic degrees and the 4 scores of the LEQ. Overall, the participants reported moderate to high leader self-efficacy with an LEQ overall score (LSME) of 70 or greater. DISCUSSION: The dynamic challenges of health care require an understanding of nursing professionals' leader self-efficacy in light of their academic preparation and activities to grow the profession.

An Applicant's Residency Program Region May Influence Where They Complete Fellowship.

The primary goal of this study was to determine if an applicant's geographic region of residency was associated with where they matched for fellowship. San Francisco Match (SF Match) provided results regarding applicant data and match results from 2014-2018 for orthopaedic subspecialties except hand and shoulder and elbow. Residency programs were divided into five regions: (Northeast [NE], Southeast [SE], Midwest [MW], Southwest [SW] and West [W]). The MW region had the fewest number of fellowship positions per applicant (0.62), the W region had the most (1.7). Applicants from each region were significantly (p < 0.0001) more likely to complete fellowship in the same region where they completed residency, and there were significant (p < 0.05) differences between regions for specific subspecialties. There are imbalances in terms of the number of applicants and specific fellowship spots available in each region. This imbalance seems important considering the strong associations found between the region in which an applicant completes residency and fellowship. Level of Evidence: Level 3. (Journal of Surgical Orthopaedic Advances 30(1):030-035, 2021).

Operative vs. Nonoperative Treatment of Isolated Humeral Shaft Fractures: A Prospective Cohort Study.

The purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score, visual analogue score (VAS) or elbow range of motion (ROM) at 6 months. However, 11% of the FB group developed nonunion. Complications in the ORIF group included a 2% infection and nonunion rate and 13% iatrogenic radial nerve dysfunction (RND). ORIF can be expected to result in higher union rates with the inherent risks of infection and RND. Finally, at 6 months, both groups demonstrated higher DASH scores than population norms, indicating a lack of full recovery. (Journal of Surgical Orthopaedic Advances 30(2):067-072, 2021).

Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?

Our purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of 15° (AUC: 0.580) at 1-year follow-up. We found increased or worse disabilities of the arm, shoulder and hand (DASH) scores with > 10° sagittal alignment or > 15° of coronal alignment. Poor DASH scores were observed at angles lower than previously accepted for nonoperative treatment. These findings are useful in decision making and patient guidance. (Journal of Surgical Orthopaedic Advances 30(2):073-077, 2021).

Residency Program Reputation Influences the American Association of Hip and Knee Surgeons Match Results.

BACKGROUND: No data evaluate the impact that an applicant's residency program reputation has on the outcome of the American Association of Hip and Knee Surgeons (AAHKS) fellowship match. This study sought to determine if an applicant's residency program ranking was associated with where the applicant matched on their rank list. METHODS: We included all the US applicants from the "San Francisco Match" regarding AAHKS applicant data and match results from 2014 to 2018. Residency programs were divided into 5 tiers based on 2018 Doximity ranking of Orthopedic Residency Programs. Statistical analysis consisted of descriptive statistics, chi-squared tests, and analysis of variance. RESULTS: In total, 656 applicants met inclusion criteria (620 males; 36 females). Tier 1 applicants applied to an average of 10 fewer programs than applicants from all other tiers. Eighteen percent of applicants from tier 1 residencies were offered interviews at 80%+ of their applied programs compared to 5% or less of the applicants from all other tiers. Applicants from top tier residencies matched at a significantly higher place on their rank list than other tiers (P < .05) and ranked into one of their first 2 choices 72% of the time. The mean fellowship rank position for tier 1 applicants was 5.96 compared to 7.04, 7.85, 7.78, and 8.10 for subsequent tiers, respectively (P < .05). CONCLUSION: The fellowship match process represents a high-stakes and expensive process. This study found that applicants from more prestigious residency programs apply to fewer programs, gain more interviews, and match higher on their rank list than applicants from other residency programs.

High Energy Midfoot Fracture-Dislocations: Does Staged Treatment with External Fixation Help?

This study analyzes the outcomes of patients treated for high energy midfoot injuries with temporary stabilization (TS) prior to definitive operative fixation compared to a control group (C) treated initially with splint only. Three Level 1 trauma centers reduced and temporized high energy Lisfranc injuries. A matched control group was compared with the intervention group. Clinical parameters, complications and need for additional surgery were evaluated. There were 15 patients in group C and 29 patients with temporary stabilization (TS). Both the TS and C groups demonstrated no significant difference in the number of additional operations, infection rate, incidence of deep vein thrombosis (DVT), nonunion and need for orthotics postoperatively (p > 0.05). Staged treatment of high energy Lisfranc injuries in the TS group led to a delay in definitive fixation or arthrodesis while having a similar minimal complication rate relative to the controls. This is a Level III, Retrospective Case Control Study. (Journal of Surgical Orthopaedic Advances 29(3):154-158, 2020).

Gunshot Wounds to the Hip: Doomed to Failure?

The purpose is to evaluate hip fractures due to gunshot wounds (GSW) to the hip, which are treated surgically, and the complications. Patients who sustained a low velocity GSW with fracture to the femoral head/neck and intertrochanteric/peritrochantric region at three Level 1 Trauma Centers were eligible. There were 69 patients (63 males-91%), with an average age of 29 (18-60). Nine patients had orthopaedic surgical site infections. There were 6 nonunions, 4 patients with hardware failure, 2 cases of avascular necrosis (AVN), 3 patients with post traumatic arthritis (PTA) and 20 patients with heterotopic ossification (HO). There was no significant difference found regarding fracture site or type of fixation with regards to complications. This represents the largest study of surgically treated GSW to the hip. Of patients studied, 61% sustained additional GSW. These injuries are not benign; the main complications being infection and heterotopic ossification. (Journal of Surgical Orthopaedic Advances 29(3):135-140, 2020).

High-Energy Midfoot Fracture-Dislocations: Staged Treatment With an External Fixator.

The purpose of this study was to analyze the clinical outcomes of patients treated for high-energy midfoot (Lisfranc) injuries with initial temporization of an external fixator before definitive fixation. A retrospective chart review at two level 1 trauma centers was completed. Clinical parameters including demographics and comorbidities were evaluated in addition to hospital and clinical data. Time to full weight bearing took an average of 4.4 months, and with the numbers available no significant difference (p < .05) was found between the open reduction and internal fixation (ORIF) group and the arthrodesis group in regard to length of stay, days from initial reduction with an external fixator to definitive fixation, time to full weight bearing, or return to work. Staged treatment of high-energy Lisfranc injuries with external fixation demonstrated minimal soft tissue complications similar to other series reported in the literature. Definitive stabilization with either ORIF or arthrodesis produced similar results in staged treatment of these injuries. (Journal of Surgical Orthopaedic Advances 28(1):24-30, 2019).

Heterotopic ossification of the elbow treated with surgical resection: risk factors, bony ankylosis, and complications.

BACKGROUND: Heterotopic ossification is the most common extrinsic cause of elbow contracture and may lead to clinically important stiffness, and rarely, complete bony ankylosis. Surgery sometimes is performed to treat this problem, and published reports differ regarding the factors that are associated with success or failure after this operation and whether the procedure is effective for patients with elbow ankylosis. QUESTIONS/PURPOSES: We wished (1) to identify potential patient characteristics and modifiable risk factors that are associated with improvements in ROM after surgery for heterotopic ossification of the elbow; (2) to compare ROM gains between patients with complete ankylosis and partially restricted ROM; and (3) to characterize the complications of elbows treated by surgical release and excision of heterotopic ossification followed by a standardized rehabilitation program. METHODS: We reviewed the records of all patients treated operatively for heterotopic ossification of the elbow from September 1999 to February 2012 at one institution by one surgeon. General indications for the surgery were clinically symptomatic or debilitating heterotopic ossification of the elbow. Each patient received prophylaxis postoperatively consisting of indomethacin (or single-shot radiation for patients with sensitivity to antiinflammatory medications). All patients received a physical therapy regimen and used a continuous passive motion machine for 6 weeks. Patient demographics, mechanism of injury, time between injury and surgery, and medical history were reviewed for comparison. Followup was at a mean of 13 months (range, 3-106 months); no patients were lost to followup. Thirty-nine patients (46 elbows) with heterotopic ossification treated with excision were identified: 10 patients (16 elbows) had burns, 28 patients (29 elbows) had trauma, and one patient (one elbow) had a closed head injury. Eight of the 39 patients (12 of 46 elbows [26%]) had complete ankylosis at the time of surgery. RESULTS: Hypertension, obesity, and absence of intraoperative anterior ulnar nerve transposition were associated with an adverse effect on change from preoperative to final arc of motion. The group with ankylosis had greater preoperative to postoperative gain in arc compared with the group with partial restriction (96°, 95% CI, 84°-107° and 59°, 95% CI, 46°-72°, respectively). For the entire cohort there was an overall improvement in mean flexion-extension arc of motion from 35° to 103° at final followup (p < 0.001; 95% CI, 57°-80°), with a 17% rate of complications (three patients [three elbows] with heterotopic ossification, three patients [three elbows] with nerve palsies, one patient [one elbow] with deep wound infection, and one patient [one elbow] with an unstable elbow). CONCLUSIONS: Patients with partially and completely restricted ROM showed substantial improvement in postoperative ROM. Hypertension, obesity, and absence of intraoperative anterior ulnar nerve transposition were negative predictors of outcome in our series. Surgery combined with postoperative prophylaxis and a regimented rehabilitation program are feasible modalities to treat patients with heterotopic ossification of the elbow. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Examination of the Relationship Between Clinical Hours and NCLEX Success.

BACKGROUND: Clinical education provides important learning opportunities for students. Finding clinical sites and faculty can be a challenge. Exploring the relationship between the number of clinical practice hours and NCLEX-RN success may be helpful for curriculum development and revision. PURPOSE: The purpose of this study was to provide descriptive information about clinical education in RN programs and determine if a relationship existed between the number of clinical hours and NCLEX-RN pass rate. METHOD: A descriptive research design using a survey was sent to over 1000 accredited nursing programs in the United States. RESULTS: One hundred and fourteen surveys were completed. When comparing 2021 NCLEX-RN pass rates with clinical hours, there was a statistically significant difference at the 500 clinical hour interval. CONCLUSION: Nursing programs can ensure fiduciary responsibility while supporting clinical judgment development and licensure success by reviewing their curriculum and reconsidering the number of clinical hours in their programs.

Attitudes toward retirement of ophthalmology department chairs.

PURPOSE: To identify common perceptions and ideas about preparation and planning for retirement of chairs of academic departments of ophthalmology, determining areas of particular stress and proposing ways to better prepare for retirement. DESIGN: Cross-sectional study. PARTICIPANTS: One-hundred sixteen chairs of academic departments of ophthalmology in the United States. METHODS: A confidential online survey emailed to ophthalmology chairs. MAIN OUTCOME MEASURES: Surveys assessed demographics; current work schedule; perceptions, preparation, and planning for retirement; and retirement training for faculty and residents. RESULTS: Ninety-six department chairs responded to the survey (82% response rate). Most chairs anticipate retiring around age 70. Significantly, only 9% are looking forward to retirement. Reasons for delaying retirement include keeping active (37%), income/insurance/benefits (20%), and maintaining lifestyle (17%). The most common concern is financing retirement (46%). Forty percent anticipate their reason for retirement will be because of age or health, whereas 20% anticipate fatigue or burnout. Nearly half of the respondents have no specific plan upon retirement. Most respondents anticipate pursuing other interests (43%); 32% intend to spend time with family, vacationing, and travelling. Younger respondents are more concerned with the financial aspects of retirement while more senior respondents appear to delay retirement to keep active or because they enjoy their work. CONCLUSIONS: Retirement is a source of stress for many ophthalmology department chairs and many indicate financial preparation is their major concern. Despite this, the major reason for putting off retirement is a desire to keep active. Developing a retirement plan eases stress and engenders a feeling of confidence about the future.

Characteristics of Adult Patients for Violence-Related Injuries Presenting to a Level 1 Trauma Center in Midwest United States.

BACKGROUND: Hospital violence intervention programs (HVIPs) have recently been initiated in trauma centers across the United States. However, violence-related injuries have unique factors and issues that should be addressed in the health care provided in emergency departments. PURPOSE: This study aimed to characterize the patient population presenting at a level 1 ACS verified trauma center, with a chief complaint of violent trauma, and identify characteristics of patients most at risk for violence-related trauma. METHODS: The cross-sectional retrospective study examined patients' electronic health records, at least 18 years, with a diagnosis of blunt or penetrating injury treated by the emergency and trauma team at level 1 ACS verified trauma center in the Midwest. RESULTS: Assault injuries accounted for most of the mechanisms that required treatment at the hospital and disposed to home. Nearly 80% of the population had no documentation of the relationship of the assailant. The average age of the patients was 33 years and black males. Eleven patients were treated in the emergency department twice for a trauma-related injury during the six-month data collection. CONCLUSION: Injuries from violence require comprehensive care from various healthcare disciplines, similar to managing acute and chronic illnesses. The American College of Surgeons (ACS) guidelines support the development of an HVIP to identify risk factors and treatment plans for any patient exposed to violence. This research demonstrates that HVIPs should provide standardized screening and follow-up care while in the emergency department or immediately following the hospital to reduce the cyclical events.

Does the addition of post-operative gabapentin reduce the use of narcotics after orthopedic surgery?

OBJECTIVES: To evaluate the efficacy of post-operative gabapentin administration as an analgesic agent and its effect on narcotic use after orthopedic surgery in an outpatient sports medicine practice by comparing patients prior to and after initiating the routine use of gabapentin as part of a standardized post-operative pain medication regimen. We hypothesized that adding gabapentin to a multimodal post-operative pain regimen would decrease the number of requested pain medication refills and have no detrimental effect on Visual Analogue Scale and Single Assessment Numerical Evaluation scores at these early post-operative visits. METHODS: All outpatient surgical patients, <90 years of age, undergoing outpatient orthopedic surgery by the study's senior author were included between 08/05/2021 and 02/22/2022. Patients were allowed 1 narcotic refill post-operatively and only in the first 3 weeks. The primary outcome was difference in percentage of patients who requested a narcotic refill within 3 weeks post-op. Two- and 6-week Visual Analogue Scale and Single Assessment Numerical Evaluation scores, and baseline health and demographic data. T-tests were run on continuous variables, Chi-Square or Fisher's Exact Test were run on dichotomous variables, and Mann-Whitney U test was run on all other categorical variables. Statistical significance was set at P < .05 for all tests. RESULTS: There was a significant difference in narcotic refills at 3 weeks: 23 pre-gabapentin patients and 9 post-gabapentin patients (22.8% vs 9.0%, respectively: P = .006). There were no differences between 2- and 6-week Visual Analogue Scale and 2-week Single Assessment Numerical Evaluation scores. There was a significant difference in 6-week SANE between groups: mean difference = 6.4 (P = .027) though less than the established MCID. CONCLUSION: Addition of gabapentin to a post-operative multimodal pain regimen reduced the use of narcotics after orthopedic sports medicine surgeries while also providing equivalent pain control.

Exploring Nurses' Perceptions of Specialty Certification.

BACKGROUND: The strategic nursing plan for a large Midwestern health care system includes achievement of the American Nurses Credentialing Center's Magnet® recognition for all their hospitals. This study explored the barriers to and perceived value of certification among nurses employed by the same health care system across eight facilities in a metropolitan region. One of these facilities holds Magnet® recognition. METHOD: Subjects were recruited by direct email to collect demographic data and complete a barrier to certification survey and the Perceived Value of Certification Tool-12. RESULTS: There were statistically significant differences in the perception that lack of institutional support is a barrier to certification both in aggregate and when comparing the Magnet® hospital with the others. CONCLUSION: As an initial exploration into barriers and perceived value, this study provides data for this health care system to plan strategies to promote certification. This study also serves as an exemplar for other organizations considering evaluation of certification barriers and value among their nursing staff. [J Contin Educ Nurs. 2023;54(12):567-573.].

The other side of conflict: Examining the challenges of female orthopaedic surgeons in the workplace.

BACKGROUND: As more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. METHODS: An anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. RESULTS: Of the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. CONCLUSIONS: Workplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.

Septic Emboli Resulting From Severe Trauma: A Primer on Care.

INTRODUCTION: Trauma nursing requires specialized knowledge and skills. This article describes the case of a patient who was involved in a motor vehicle accident and presented to the emergency department with hypovolemic shock secondary to a splenic laceration. In the hospital, the patient experienced prolonged hypotension. CLINICAL FINDINGS: The patient sustained a variety of insults to the cardiovascular, respiratory, endocrine, and musculoskeletal systems. Microbiological data and laboratory test results did not reveal the defining characteristics of sepsis or systemic inflammatory response syndrome typical of trauma patients, making it challenging to identify the source of the sepsis. DIAGNOSIS: The patient was diagnosed with nontraumatic cerebral septic emboli, a condition that is less common in trauma patients and more common in cases of endocarditis, septic thrombophlebitis, and central venous catheter infections. The condition has a 50% mortality rate if not detected promptly and appropriate treatment administered. OUTCOMES: The patient survived the 4-week hospitalization owing to timely management of his conditions by the health care team and their persistence in identifying the cause of his atypical sepsis. CONCLUSION: To provide adequate care to trauma patients, critical care nurses require specialized knowledge of this unique population. Trauma critical care nursing should involve hands-off communication, thoughtful review of laboratory test and imaging results, and engagement in interdisciplinary care rounds.

Preparedness to Write Items for Nursing Education Examinations: A National Survey of Nurse Educators.

BACKGROUND: Nursing programs in the United States primarily use multiple-choice questions to prepare students for the NCLEX. BACKGROUND: Nursing programs in the United States primarily use multiple-choice questions to prepare students for the NCLEX. Currently, the optional next-generation NCLEX is testing the validity and reliability of situational case studies. PURPOSE: The purpose of this study was to investigate the preparedness and confidence of nurse educators in writing NCLEX-style questions. METHODS: A descriptive survey design with snowball sampling was used to collect the data and was sent to 1550 deans/directors/coordinators of publicly available email addresses of accredited schools of nursing. RESULTS: A total of 300 participants completed the survey from 44 states. When asked about confidence in writing NCLEX-style items, those who received formal education or training reported being somewhat confident (51%), whereas those who did not reported ambivalent or not confident (49%). CONCLUSION: Surveyed nurse educators lack confidence in writing questions and feel unprepared for the new question types instituted by the NCSBN in 2023. Nurse educators need continued education to develop and review NCLEX-style items and examinations.

Burn trauma from a space heater requiring paraspinal muscle flap back reconstruction with skin grafting: A case report.

Full-thickness burns damage all layers of skin and may also damage underlying tissue including bones, muscles, and tendons. Full-thickness burns almost always require immediate medical and surgical management. Some may require extensive bone, muscular, and other reconstructive surgery depending on the depth of involvement of surrounding tissues. Bone exposure in burn patients can lead to unique complications including osteomyelitis. We present the case of an elderly patient with a history of dementia who presented with full-thickness burns to the back with exposed spinal elements who later developed osteomyelitis requiring lumbar spine reconstruction with bilateral paraspinous muscle flap for back reconstruction, adjacent tissue transfer, and split thickness skin grafting. This case represents the severity of full-thickness burns with underlying bone exposure and the importance of aggressive wound care and multidisciplinary team approach.