A framework of the institutional policies and practice environments of nurse practitioner primary care models: A cross-case analysis.

PURPOSE: The purpose of this article was to compare the implementation of distinct models of nurse practitioner (NP) integration into primary care offices. DESIGN/METHODOLOGY: A multiple case study design of three NP primary care practice models allowed for in-depth exploration of the management processes supporting the utilization of NPs. At each site, semistructured qualitative interviews, document review, and site tours/observations were conducted and subject to cross-case analysis guided by the NP Primary Care Organizational Framework (NP-PCOF)-developed for this study based on existing theory. RESULTS: Our case study sites represent three distinct NP primary care models. In the restricted practice model, NPs care for same-day/walk-in acute patients. NPs in the independent practice model have an independent panel of patients and interact collegially as independent coworkers. NPs in the comanagement model function on a team (a physician and two NPs), have a team office space, collectively care for a shared panel of patients, and can earn financial bonuses contingent upon meeting team quality metrics. Our cross-case analysis confirmed differences in physical space design, the relational structure of a workplace, and the capacity for innovation via NP compensation and performance metrics across different NP primary care models. CONCLUSION: Our findings suggest that NP primary care models are supported by complex management systems and the NP-PCOF is a tool to help understand this complexity. IMPLICATIONS: The NP-PCOF is a framework to understand the management systems that facilitate the utilization of NPs within primary care organizations.

Hospital- and System-Wide Interventions for Health Care-Associated Infections: A Systematic Review.

Hospitals face increasing pressure to reduce health care-associated infections (HAI) due to their costs and evidence of preventability. However, there is limited synthesis of evidence regarding interventions that can be successfully implemented hospital- or system-wide. Using Donabedian's structure-process-outcome model, we conducted a systematic literature review from 2008 to early 2019, identifying 96 studies with 214 outcomes examining the relationship between hospital- or system-wide interventions and HAIs. This literature's methodologic and reporting quality was generally poor. The most common HAIs studied were methicillin-resistant Staphylococcus aureus (22%) and Clostridium difficile (21%). 97 outcomes showed a desirable change, 72 showed no significant effect, 17 showed conflicting effects, and 3 found undesirable effects; 25 outcomes were from studies without a statistical analysis. Our findings highlight structural and process approaches meriting additional research and policy exploration, and identify recommendations for future investigation and reporting of hospital and system-wide HAI interventions to address gaps in existing literature.

Publisher Correction: Early preclinical detection of prions in the skin of prion-infected animals.

The original version of this Article contained errors in the author affiliations. Affiliation 2 incorrectly read 'Department of Neurology, The First Hospital of Jilin University, Changchun 130021 Jilin Province, China.'Affiliation 5 incorrectly read 'Department of Otolaryngology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061 Shanxi Province, China'Affiliation 9 incorrectly read 'State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.'This has now been corrected in both the PDF and HTML versions of the Article.

Early preclinical detection of prions in the skin of prion-infected animals.

A definitive pre-mortem diagnosis of prion disease depends on brain biopsy for prion detection currently and no validated alternative preclinical diagnostic tests have been reported to date. To determine the feasibility of using skin for preclinical diagnosis, here we report ultrasensitive serial protein misfolding cyclic amplification (sPMCA) and real-time quaking-induced conversion (RT-QuIC) assays of skin samples from hamsters and humanized transgenic mice (Tg40h) at different time points after intracerebral inoculation with 263K and sCJDMM1 prions, respectively. sPMCA detects skin PrPSc as early as 2 weeks post inoculation (wpi) in hamsters and 4 wpi in Tg40h mice; RT-QuIC assay reveals earliest skin prion-seeding activity at 3 wpi in hamsters and 20 wpi in Tg40h mice. Unlike 263K-inoculated animals, mock-inoculated animals show detectable skin/brain PrPSc only after long cohabitation periods with scrapie-infected animals. Our study provides the proof-of-concept evidence that skin prions could be a biomarker for preclinical diagnosis of prion disease.

Artificial strain of human prions created in vitro.

The molecular mechanism that determines under physiological conditions transmissibility of the most common human prion disease, sporadic Creutzfeldt-Jakob disease (sCJD) is unknown. We report the synthesis of new human prion from the recombinant human prion protein expressed in bacteria in reaction seeded with sCJD MM1 prions and cofactor, ganglioside GM1. These synthetic human prions were infectious to transgenic mice expressing non-glycosylated human prion protein, causing neurologic dysfunction after 459 and 224 days in the first and second passage, respectively. The neuropathology, replication potency, and biophysical profiling suggest that a novel, particularly neurotoxic human prion strain was created. Distinct biological and structural characteristics of our synthetic human prions suggest that subtle changes in the structural organization of critical domains, some linked to posttranslational modifications of the pathogenic prion protein (PrPSc), play a crucial role as a determinant of human prion infectivity, host range, and targetting of specific brain structures in mice models.