ABSTRACT
Given the importance of understanding health outcomes at fine spatial scales, iterative proportional fitting (IPF), a form of small area estimation, was applied to a fixed number of health-related variables (obesity, overweight, diabetes) taken from regionalized 2019 survey responses (n = 5474) from the Idaho Behavioral Risk Factor Surveillance System (BRFSS). Using associated county-level American Community Survey (ACS) census data, a set of constraints, which included age categorization, race, sex, and education level, were used to create county-level weighting matrices for each variable, for each of the seven (7) Idaho public health districts. Using an optimized modeling construction technique, we identified significant constraints and grouping splits for each variable/region, resulting in estimates that were internally and externally validated. Externally validated model results for the most populated counties showed correlations ranging from .79 to .85, with p values all below .05. Estimates indicated higher levels of obesity and overweight individuals for midsouth and southwestern Idaho counties, with a cluster of higher diabetes estimates in the center of the state (Gooding, Lincoln, Minidoka, and Jerome counties). Alternative external sources for health outcomes aligned extremely well with our estimates, with wider confidence intervals in more rural counties with sparse populations.
ABSTRACT
Assessment and evaluation of competency for advanced practice registered nurses (APRNs) is a challenge facing educators, regulators, and consumers of health care. The purpose of this study was to determine the effectiveness of using simulation to assess and evaluate APRN student competence in managing complex cases. Students were videotaped in the simulation laboratory at four separate intervals; two independent reviewers used the APRN Competency Evaluation Tool to review the simulation. Results showed statistically significant improvement in all categories of evaluation following increased exposure to simulation of complex cases. Student competence increased for managing complex patients, use of evidence-based guidelines, patient safety, leadership, prioritization, delegation, collaboration, communication, and professionalism.
Subject(s)
Advanced Practice Nursing/education , Clinical Competence , Education, Nursing, Graduate/methods , Manikins , Educational Measurement , Humans , Models, Educational , Nursing Education Research , Pilot ProjectsABSTRACT
Acute abdominal pain represents the cardinal symptom of a large number of intra-abdominal pathologies. Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The clinician's goal for patients with acute abdominal pain is to rapidly identify whether the underlying cause requires an urgent or immediate surgical intervention. By developing a systematic approach to evaluating patients with abdominal pain, clinicians can generate a differential diagnosis to ensure appropriate treatment and improved patient outcomes. The purpose of this article is to provide clinicians with a framework for evaluating the complaint of acute abdominal pain and recognizing patients who require expedited evaluation.
Subject(s)
Abdominal Pain/diagnosis , Abdominal Pain/etiology , Diagnosis, Differential , Humans , Medical History TakingABSTRACT
The "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines" is a major revision of the 2004 guideline. This article provides a synopsis and review of the guideline focusing on changes in patient care and implementing processes to ensure quality care. The implementation of this guideline provides nursing with a unique opportunity to affect patients and families primarily by recognition of the event and education about lifestyle modification and disease management. Regionalization of emergency systems provides a novel situation for nursing to develop interdepartmental and system protocols.
