Nurse Practitioner Care Model: Meeting the Health Care Challenges With a Collaborative Team.

In today's environment, organizational delivery systems must produce high-quality, efficient, and cost-effective services. Central to restructuring care delivery is the evolving role of the nurse practitioner (NP) and the integration of the role as part of the health care workforce. The NP Care Model was designed and introduced to the organizational workforce in a medical center to coordinate, manage, and monitor the outcomes of high-risk patients with chronic disease efficiently. This program focused specifically on patients with heart failure who were discharged to home and identified to be at high-risk for early readmissions. The Healthy Heart Initiative prograrr coordinated by the NP addressed targeted causes of rehospitalization (lifestyle, medication and diet noncompliance, and lack of self-care disease management). The program objective of improved financial performance were met by reducing the 30-day readmission rate. Operational effectiveness and quality patient outcomes were met through the design and implementa tion of the NP Care Model, and overall patient reported satisfaction.

LOCALIZATION OF MICROCYSTIN SYNTHETASE GENES IN COLONIES OF THE CYANOBACTERIUM MICROCYSTIS USING FLUORESCENCE IN SITU HYBRIDIZATION(1).

To better understand the production of microcystins (MCs) in Microcystis colonies, fluorescence in situ hybridization (FISH) methods were developed to detect DNA involved in the synthesis of these cyanobacterial hepatotoxins. Using colonies of Microcystis aeruginosa (Kütz.) Kütz. isolated from environmental blooms of cyanobacteria and from a colony-forming, MC-producing laboratory strain of Microcystis, amplified PCR products were observed, coincident with positive controls. The total MC content of individual colonies of Microcystis, determined by ELISA, showed a positive correlation with colony cross-sectional area. FISH analysis of Microcystis colonies gave high fluorescence in comparison to negative controls, indicating the presence of MC synthetase DNA (mcyA) in situ. FISH analysis for MC synthetase genes has the potential to be developed into an effective early warning tool for drinking and recreational water management.

Oral care of the critically ill: a review of the literature and guidelines for practice.

Maintaining oral health in the critically ill patient is imperative in reducing the risk of nosocomial infections and improving patient comfort and discharge outcomes. Critically ill patients are at great risk for poor oral health as many are elderly, undernourished, dehydrated, immunosuppressed, have a smoking or alcohol history, are intubated or on high-flow oxygen, and are unable to mechanically remove dental plaque. Many modalities for delivering oral care have been reported in the literature. The use of the toothbrush in the mechanical removal of plaque, even in the intubated patient, has been proven to be superior to the swab. Brushing of the gums in edentulous patients is of benefit. Although electric toothbrushes are preferable, their cost, size and the potential for cross-infection limits their use. Chlorhexidine has long been the gold standard for mouthwashes and provides up to 24 hours of antimicrobial activity; therefore infrequent applications are adequate. Sodium bicarbonate and hydrogen peroxide are of limited use due to lack of convincing evidence regarding their safety and antimicrobial effects in the critically ill population. Saliva stimulants or substitutes including lemon and glycerine are also inappropriate for moistening the oral cavity in the critically ill patient. Regular oral assessment and individualized oral care, along with the use of a standardised protocol for oral care (incorporating proven modalities) is vital for optimal oral care in the critically ill patient.