Associations of Incomplete SARS-CoV-2 Vaccination among Patients with Unstable Housing in Houston.

Vaccination is a safe and effective way to protect against SARS-CoV-2. Two of the three authorized SARS-CoV-2 vaccines require two doses, presenting logistical challenges. Those with unstable housing face barriers that amplify these challenges. In this study, we utilized a database maintained by Healthcare for the Homeless-Houston to determine the rates of partial vaccination among those with unstable housing in Houston (n=294). We then performed post-hoc analyses to identify predictors of partial vaccination. Our key finding was that 30% of those with unstable housing missed their second dose, a proportion far higher than the national average. Those with permanent supportive housing and those who had a Harris County Gold Card (financial assistance for health care costs) were more likely to return for dose two, while those who were younger, living on the streets, or staying in a temporary homeless shelter were more likely to miss the second dose.

Examining the Effects of Whole Crop Wheat Silage on Ewe Performance during Late Gestation Compared to Traditional Grass Silage across Three Prolific Breed Types.

Provision of adequate nutrient intake in late gestation of the ewe is an important determinant of dam and offspring performance. A 2 × 3 factorial design experiment examining two forage types, whole crop wheat silage (WCWS) or grass silage (GS) offered to one of three prolific breed types, (Belclare X, Lleyn X, Mule (Bluefaced Leicester × Blackface Mountain)), was conducted. Forage type had no impact on dry matter (DM) or metabolizable energy (ME) intake, body weight and body condition score change, or colostrum production (p > 0.05). Ewes offered WCWS had lower crude protein (CP) intake (p < 0.0001) and a lower combined litter weight (p < 0.05). Mule ewes consumed less DM, CP, (p < 0.05), and ME (p < 0.01) compared to Belclare X and Lleyn X ewes however, water intake per kg DM consumed did not differ with breed type (p > 0.05). Colostrum yield over the first 18 h postpartum was lower for Mule ewes compared to other breed types (p < 0.05). In conclusion, results from this study suggest nutrient concentration and balance as opposed to forage type is important for late gestation nutrition and breed type can impact feed intake and colostrum yield.

Professionalism: a necessary ingredient in a culture of safety.

BACKGROUND: A safety culture requires the highest levels of professionalism. A Code of Professionalism was created in an obstetrics service line as a mechanism to address unprofessional behavior. In this initiative, a multidisciplinary Code of Professionalism was established, with the support of leadership and the employee and nursing unions, to help create a safety culture. METHODS: In 2005 the Code of Professionalism was introduced to physicians, nurses, and support staff. The U.S. Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Survey was used, along with a portion of the Institute for Safe Medication Practices (ISMP) Survey on Workplace Intimidation to measure changes in the safety culture. Data were collected in 2005, 2008, and 2011. RESULTS: One hundred thirty-four reports were made to the committee on professionalism between February 2005 and December 2010. Some 96 (72%) of the reports were submitted by nurses, with physicians accounting for 13%. Seventy-five of the reports (56%) were about unprofessional behavior by physicians and 46 (34%) were about unprofessional nursing behavior. On the AHRQ Patient Safety Culture Survey, statistically significant improvement was shown in the Teamwork Within Units dimension, from 2005 to 2008; the Management Support dimension, from 2005 to 2008; the Organizational Learning dimension, from 2005 to 2008 and also from 2008 to 2011; and the Frequency of Events Reported dimension, from 2008 to 2011. DISCUSSION: Implementing a multidisciplinary Code of Professionalism can improve the safety culture in a hospital. When leadership sets clear standards and holds physicians and staff to the same standard, improvements in an organization's safety culture can serve as the foundation for the delivery of safer care.

Nurses' attitudes toward nursing research at a metropolitan medical center.

To support the implementation of a nursing research initiative in a large medical center, we collected baseline data on nurses' attitudes toward nursing research, perception of the institution as a research environment, and personal involvement in research activities. This study replicates that conducted by Rizzuto, Bostrom, Suter, and Chenitz [Predictors of nurses' involvement in research activities. Western Journal of Nursing Research, 16(2), 193-204] in 1994. To better understand the findings, we traced the historical evolution of nursing research through successive American Nurses Association codes of ethics. Our review of the literature presents (in table format) factors that encourage and those that impede nursing research. The study results validate the work of other researchers: nurses' positive attitudes toward research are discordant with their actual involvement in research activities. The data suggest that positive attitudes and perceived institutional support are not enough to increase involvement in nursing research; as such, we describe additional institutional infrastructure and forms of educational support.

Measuring practice patterns among acute care nurse practitioners.

OBJECTIVE: This initiative was designed to develop a reliable instrument to measure the activities of acute care nurse practitioners (ACNPs). A sound, standardized method for measuring ACNP productivity will assist nursing leaders and administrators to demonstrate the effectiveness and productivity of ACNPs in and across institutions and systems. BACKGROUND DATA: Current research on ACNPs uses many different methodologies and research designs, and fails to provide standard definitions to measure practice patterns, making it difficult to generalize across settings. METHODS: Advisory groups from 2 New York academic health science centers developed a survey that covered the demographic, educational, and employment characteristics of ACNPs, and a 20-item classification of advanced practice nursing activities. Sixty-one ACNPs completed surveys, a 58% response rate. RESULTS: The survey found strong similarities at both institutions. ACNPs spend most of their time in 5 activities involving direct care and 4 activities within indirect care. Strong Cronbach alphas confirmed that the instrument was reliable. CONCLUSIONS/IMPLICATIONS: The availability of a reliable instrument for measuring ACNP practice patterns provides administrators with a powerful tool to demonstrate the contributions of their ACNPs. In addition, a standardized method for data collection can contribute to healthcare workforce policy discussions.

Physicians' reasons for failing to deliver effective breast cancer care: a framework for underuse.

OBJECTIVE: Despite numerous randomized trials showing the health benefits of systemic and local therapies for early-stage breast cancer, underuse of these therapies remains a significant quality problem. Little is known about causes of underuse of effective cancer treatments. We sought to understand these causes to design effective interventions to improve care. RESEARCH DESIGN: To identify categories of causes of underuse, semistructured interviews were performed with physicians of breast cancer patients who did not receive effective adjuvant care in the 4 years following surgery. Underuse was defined by expert consensus based on evidence-based guidelines. SUBJECTS: Surgeons (n = 13) of all early-stage breast cancer cases who underwent surgical treatment at a tertiary care hospital and had underuse of local or systemic adjuvant therapies. RESULTS: Of all the 275 women with early-stage breast cancer, there were 44 episodes of underuse of effective therapies (16%). In 48% of cases, physicians thought treatment should occur but the treatment failed to take place (32%) or the patient refused (16%). For the other 52% of cases, physicians thought treatment should not occur because evidence did not support treatment in clinical circumstances such as older age (32%), a good prognosis based on tumor size or histology (11%), a second primary breast cancer (5%), or because of comorbidities (5%). All surgeons were aware of the benefits of adjuvant treatments. CONCLUSIONS: Causes of underuse can be identified and categorized. Using these categories, a framework of causes of underuse was constructed and interventions targeting the specific causes to improve the quality of care are suggested.