Reducing the incidence and mortality of traumatic brain injury in Latin America.

Traumatic brain injury (TBI) represents a considerable portion of the global injury burden. The incidence of TBI will continue to increase in view of an increase in population density, an aging population, and the increased use of motor vehicles, motorcycles, and bicycles. The most common causes of TBI are falls and road traffic injuries. Deaths related to road traffic injury are three times higher in low-and middle-income countries (LMIC) than in high-income countries (HIC). The Latin American Caribbean region has the highest incidence of TBI worldwide, primarily caused by road traffic injuries. Data from HIC indicates that road traffic injuries can be successfully prevented through concerted efforts at the national level, with coordinated and multisector responses to the problem. Such actions require implementation of proven measures to address the safety of road users and the vehicles themselves, road infrastructure, and post-crash care. In this review, we focus on the epidemiology of TBI in Latin America and the implementation of solutions and preventive measures to decrease mortality and long-term disability.

Neurosurgery in East Africa: Innovations.

In the last 10 years, considerable work has been done to promote and improve neurosurgical care in East Africa with the development of national training programs, expansion of hospitals and creation of new institutions, and the foundation of epidemiologic and cost-effectiveness research. Many of the results have been accomplished through collaboration with partners from abroad. This article is the third in a series of articles that seek to provide readers with an understanding of the development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare in the region (Innovations). In this article, we describe the ongoing programs active in East Africa and their current priorities, and we outline lessons learned and what is required to create self-sustained neurosurgical service.

Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes.

Structured hourly nurse rounding is an effective method to improve patient satisfaction and clinical outcomes. This program evaluation describes outcomes related to the implementation of hourly nurse rounding in one medical-surgical unit in a large community hospital. Overall Hospital Consumer Assessment of Healthcare Providers and Systems domain scores increased with the exception of responsiveness of staff. Patient falls and hospital-acquired pressure ulcers decreased during the project period.

Birth mother grief and the challenge of adoption reunion contact.

A large body of work exists on the grief expressed by birth mothers over the loss of their children to adoption. Less is known about the grief emotions that surface when these women are contacted by adopted adults who seek contact relationships. The themes of mourning, grief, and bereavement that emerged in the qualitative interview data of 33 reunited birth mothers indicate more attention be given to these social psychological processes. Suggestions for future research possibilities and implications for clinical practice are explored.

Improving care of patients with insulin pumps during hospitalization: translating the evidence.

The purpose of this quality improvement project was to determine whether implementation of an evidence-based standardized protocol would enhance documentation and management of blood glucose levels for patients using continuous subcutaneous insulin infusion during hospitalization. Using a comparative design, documentation and blood glucose control measures were assessed before and after implementation of the protocol. Although some improvements have been recognized, we continue to refine the process and anticipate stronger outcomes in the future.

Rx for NCLEX-RN success: reflections on development of an effective preparation process for senior baccalaureate students.

This article highlights the process employed to support and facilitate student preparation for NCLEX-RN success at a baccalaureate institution that experienced a decline in pass rates subsequent to increased enrollment. The multifaceted approach emphasizes individualized attention; strategies to augment student self-confidence, enhancement of critical thinking skills, self-assessment of test-taking abilities, development of a feasible study plan utilizing learned effective study techniques; and the acknowledgment of barriers and identification of specific methods to overcome them. In place since spring 2006, consistently improved measurable outcomes are evident without the added student stress of consequences for failing to attain a benchmark score on an end-of-program examination.

CSI: New @ York: development of forensic evidence collection guidelines for the emergency department.

Emergency department (ED) nurses care for victims of trauma almost daily. Although preservation of evidence is crucial, the ED is chaotic when a trauma patient arrives and staff members must do everything possible to save the patient's life. However, an integral responsibility of the staff nurse is collection and preservation of forensic evidence. This article provides insight into the process undertaken by a multidisciplinary team to develop a set of evidence-based guidelines for forensic evidence collection. The team compiled evidence from more than 20 articles and consultations with law enforcement officials and forensic experts. This information was used to develop a set of guidelines for forensic evidence collection in the ED or operating room. Staff educational needs presented some challenges. Training was designed to specifically address the roles of three major groups of staff: patient representatives and emergency and trauma nurses. Educational topics included evidence recognition, handling of clothing, gross/trace evidence, documentation, packaging of evidence, and use of the "chain-of-evidence" form. Practice modifications included development of a new "chain-of-evidence" form, a forensic cart in the operating room, and use of a collapsible plastic box for collection of clothing in the ED.

Intracranial pressure monitoring: why monitor?

Evidence suggests that the mortality and morbidity of acquired brain injury could be reduced if clinicians used an aggressive intracranial pressure guided approach to care. Despite nearly 50 years of evidence that intracranial pressure monitoring benefits patient care, only about half of the patients who could benefit are monitored. Some clinicians express concerns regarding risks such as bleeding, infections, and inaccuracy of the technology. Others cite cost as the reason. This article discusses the risks and benefits of intracranial pressure monitoring and the current state of evidence of why patients should be monitored.