Checklist-based approach to measure milker behavior before and after training.

So far, evaluation of training initiatives for dairy farm employees has been limited to the reaction and learning level. The effect of training on dairy farm employees' behavior has not been studied yet. The objective of this study was to determine the effectiveness of online training to change employee behavior toward best-practice routines. An interactive training course related to udder health was developed in 5 modules in Spanish and English: (1) collecting an aseptic milk sample, (2) administering intramammary treatment, (3) deciding on salable milk, (4) treating a cow at dry-off with antibiotics, and (5) administering teat sealants. Participants navigated the modules at their own pace or watched a narrated video. Employees were assessed performing 2 procedures related to dry cow treatment (i.e., treating a cow at dry-off with antibiotics, administering internal teat sealant) by using an objective structured clinical examination. If possible, all employees were scored performing the procedure on 2 cows before and within 2 to 3 wk after the training was applied.

Results of Robotic-Assisted Versus Manual Total Knee Arthroplasty at 2-Year Follow-up.

Robotic-assisted technology has been developed to optimize the consistency and accuracy of bony cuts, implant placements, and knee alignments for total knee arthroplasty (TKA). With recently developed designs, there is a need for the reporting longer than initial patient outcomes. Therefore, the purpose of this study was to compare manual and robotic-assisted TKA at 2-year minimum for: (1) aseptic survivorship; (2) reduced Western Ontario and McMaster Universities Osteoarthritis Index (r-WOMAC) pain, physical function, and total scores; (3) surgical and medical complications; and (4) radiographic assessments for progressive radiolucencies. We compared 80 consecutive cementless robotic-assisted to 80 consecutive cementless manual TKAs. Patient preoperative r-WOMAC and demographics (e.g., age, sex, and body mass index) were not found to be statistically different. Surgical data and medical records were reviewed for aseptic survivorship, medical, and surgical complications. Patients were administered an r-WOMAC survey preoperatively and at 2-year postoperatively. Mean r-WOMAC pain, physical function, and total scores were tabulated and compared using Student's t-tests. Radiographs were reviewed serially throughout patient's postoperative follow-up. A p < 0.05 was considered significant. The aseptic failure rates were 1.25 and 5.0% for the robotic-assisted and manual cohorts, respectively. Patients in the robotic-assisted cohort had significantly improved 2-year postoperative r-WOMAC mean pain (1 ± 2 vs. 2 ± 3 points, p = 0.02), mean physical function (2 ± 3 vs. 4 ± 5 points, p = 0.009), and mean total scores (4 ± 5 vs, 6 ± 7 points, p = 0.009) compared with the manual TKA. Surgical and medical complications were similar in the two cohorts. Only one patient in the manual cohort had progressive radiolucencies on radiographic assessment. Robotic-assisted TKA patients demonstrated improved 2-year postoperative outcomes when compared with manual patients. Further studies could include multiple surgeons and centers to increase the generalizability of these results. The results of this study indicate that patients who undergo robotic-assisted TKA may have improved 2-year postoperative outcomes.

A Crosswalk Analysis Between Magnet® Standards and Clinical Nurse Specialist Practice Competencies.

OBJECTIVE: The purpose of this study was to determine the alignment between the American Nurses Credentialing Center's Magnet Recognition Program® standards and clinical nurse specialist (CNS) practice competencies. BACKGROUND: Despite documentation of CNS contributions to achieving and sustaining Magnet Recognition®, there is a lack of evidence clearly aligning Magnet® standards and CNS practice competencies. METHODS: Using a crosswalk method, an expert panel of CNSs and chief nursing executives analyzed alignment of the 50 Magnet standards with the 44 National Association of Clinical Nurse Specialists core practice competencies. RESULTS: CNS practice competencies are aligned closely with Magnet standards: 86% of the 50 Magnet standards aligned with at least 1 CNS competency and 81.8% of CNS competencies aligned with at least 1 Magnet® standard. CONCLUSIONS: The alignment between Magnet standards and CNS competencies supports evidence of CNS contributions to organizational achievement of Magnet Recognition and will assist nurse executives in identifying a full scope of opportunities for CNSs to contribute to nursing excellence.

The Advanced Practice Clinical Nurse Specialist.

The clinical nurse specialist (CNS), one of the 4 advanced practice registered nurse (APRN) categories, has a unique role to play in contributing to high-quality patient care and system-level change across multiple health care settings. CNS practice requires advanced knowledge and skills, including specialty expertise, the ability to integrate new knowledge and innovation into the system of care, the ability to consult and collaborate with all health professions, and the mentoring of nursing staff to support and fully implement that new knowledge. The purpose of this article was to describe the role of the CNS, explain the background of the CNS role as it relates to APRN practice, provide current CNS workforce statistics, and share opportunities for hospitals and health systems to strategically use CNSs to advance patient and organizational goals.

Development, reliability, and validity of the Posttraumatic Stress Disorder Interview for Vietnamese refugees: a diagnostic instrument for Vietnamese refugees.

The Posttraumatic Stress Disorder Interview for Vietnamese Refugees (PTSD-IVR) was created specifically to assess for the presence of current and lifetime history of premigration, migration, encampment, and postmigration traumas in Vietnamese refugees. The purpose of the present study was to describe the development of and investigate the interrater and test-retest reliability of the PTSD-IVR and its validity in relation to the diagnoses obtained from the Longitudinal, Expert, and All Data (LEAD; Spitzer, 1983) standard. Clinicians conducted the diagnosis process with 127 Vietnamese refugees using the LEAD standard and the PTSD-IVR. Assessment of the reliability and validity of the PTSD-IVR yielded good to excellent AUC (area under the receiver operating characteristic curve; .86, .87) and κ values (.66, .74) indicating the reliability of the PTSD-IVR and the agreement between the LEAD procedure and the PTSD-IVR. The results of the present study suggest that the PTSD-IVR performs successfully as a diagnostic instrument specifically created for Vietnamese refugees in their native language.

The role of the CNS in achieving and maintaining Magnet status.

OBJECTIVE: The purpose of this study was to describe the role of clinical nurse specialists (CNSs) in achieving and maintaining Magnet designation. BACKGROUND: Anecdotal evidence indicates that CNSs are effective in helping hospitals achieve Magnet designation. However, there is no empirical evidence to support these statements. METHODS: Using an anonymous descriptive survey design, surveys were sent to chief nursing officers from Magnet facilities. Information collected included facility descriptions, presence and employment patterns of CNSs, and CNS importance in relation to the Forces of Magnetism. RESULTS: Clinical nurse specialists were employed in 87% of the facilities. Of those, 88% indicated that CNSs were important in achieving Magnet status, and 92% indicated that CNSs were important in maintaining Magnet status. The Force of Magnetism related to consultation and resources was perceived as most influenced by CNSs. CONCLUSION: Most Magnet hospitals employed CNSs. They were perceived as important in achieving and maintaining Magnet status.