Predictors of Recurrent Hospitalizations and the Importance of These Hospitalizations for Subsequent Mortality After Incident Transient Ischemic Attack.

BACKGROUND: We examined predictors of recurrent hospitalizations and the importance of these hospitalizations for subsequent mortality after incident transient ischemic attacks (TIA) that have not yet been investigated. METHODS: Adults hospitalized for TIA from 2000 through 2017 were examined for recurrent hospitalizations, days, and percentage of time spent hospitalized and long-term mortality. RESULTS: Of 266 patients hospitalized for TIA, 122 died, 212 had 826 anycondition hospitalization (59 from TIA-related conditions) corresponding to 3384 inpatient days during 1693 person-years of follow-up. Of 42 patient-level characteristics, age greater than or equal to 65 years (Incidence rate ratio [IRR] 1.75, 95% confidence interval [CI] 1.19-2.55), current smoking (IRR 2.15, 95% CI 1.39-3.33), concurrent heart failure (IRR 1.81, 95% CI 1.17-2.80) or anemia (IRR 1.90, 95% CI 1.40-2.48), and no prescription statin (IRR 1.45, 95% CI 1.04-2.03, P = .0289) emerged as significant predictors of anycondition rehospitalization. All these variables except heart failure remained significant predictors of TIA-related rehospitalizations. All-cause mortality was significantly increased after each hospitalization from anycondition (hazard ratio [HR] 1.32, 95% CI 1.26-1.39), TIA-related condition (HR 1.72; 95% CI 1.28-2.30), and per each day (HR 1.05, 95% CI 1.04-1.05) and per 1% of follow-up time spent hospitalized from anycondition (HR 1.45, 95% CI 1.34-1.58). CONCLUSIONS: Older age, current tobacco smoking, concurrent heart failure or anemia, and no prescription statin, easily measured patient-level characteristics, identifies patients with TIA at high risk for recurrent hospitalizations and the burden of these hospitalizations predicts subsequent mortality.

A preceptor café: serving up universal values for preceptors.

How do you affirm meaning and articulate values that will serve as the bedrock of a preceptor program? The Medical Specialty Preceptor Committee in a large hospital system planned a series of preceptor forums for 88 medical specialty preceptors. The goals were to renew commitment, refresh vision, and develop strategies for successfully orienting new hires. This study began by examining the work of JoEllen Koerner in her book Healing Presence: The Essence of Nursing. The universal values in her model involve acknowledging and addressing three basic levels: safety needs, relationship needs, and self-esteem needs, encompassing the individual's connection to the external world. The middle level is labeled transformation and goes beyond the first three levels to how the individual expresses the authentic self within the working world. The higher levels involve intuition, intention, and self-actualization and focus on the inner world of the individual. The needs of orientees could be met in all of these dimensions, based on existing structure and process in the organization. Relationship-based care as our nursing model guides holistic care. Our rich institutional heritage promotes values-based teamwork. Our goal was to articulate these values and hold discussions among preceptors about how these values could be expressed and developed in orientees. These café conversations were held as spring forum sessions. This article highlights essential ideas at the core of this preceptor activity.