Clinical Nurse Specialist Role Advocacy: Quantifying the Financial Contributions Via Development of a Scorecard.

PURPOSE/OBJECTIVES: The purpose of this article is to guide the clinical nurse specialist in constructing a scorecard to track clinical outcomes and identify the associated financial impact. DESCRIPTION OF THE PROJECT/PROGRAM: Creation of a scorecard highlighting the financial impact of the clinical nurse specialist team was used to disseminate financial outcomes to hospital executive stakeholders, allowing the clinical nurse specialist team to demonstrate its clinical and financial value. OUTCOME: During development and ongoing maintenance of the scorecard, the clinical nurse specialist team cultivated skills to identify the financial impact of projects. The team also utilized financial implications of individual and group projects to prioritize work. At the end of fiscal year 2022, the clinical nurse specialist team demonstrated revenue generation of $29 890 and cost avoidance of $2 854 807.30. The clinical nurse specialist scorecard was presented quarterly to the chief nursing officer, who shared with executive leadership. CONCLUSION: Clinical nurse specialists are positioned to make significant and positive financial impact to organizations. A scorecard presented to executive leadership offers a clinical nurse specialist team a tool to capture and disseminate a clinical nurse specialist team's unique financial contribution at the system level.

Left ventricular assist device-related infections: does the time of onset matter?

A frequent complication of left ventricular assist devices (LVAD) is the LVAD-associated infections (LVADIs). Contamination may occur during initial surgery/admission or at a later time. We studied the clinical manifestations and outcomes of LVADIs depending on the time of the onset. Patients implanted with LVADs at our institution between August 2009 and December 2014 were included. Patients were stratified into 2 groups based on whether the infection occurred early (< 180 days) or late (≥ 180 days) after LVAD implantation. Out of 37 overall LVADI episodes, 16 (43%) and 21 (57%) occurred early or late after device implantation, respectively. Median time to first LVADI was 88 ± 35 vs. 456 ± 187 days between groups. While superficial driveline-related infection was the most common LVADI type for both groups (56 vs. 71%, p = 0.489), driveline drainage was more prevalent in the late group (24 vs. 69%; p = 0.009). Early LVADIs involved more gram-positive flora, mostly Staphylococcus aureus (69 vs. 33%, p = 0.049), whereas late LVADIs involved more gram-negative pathogens, mostly Pseudomonas aueroginosa (25 vs. 57%; p = 0.045). High rates of treatment failure were consistent between groups (88 vs. 71%, p = 0.384). Compared with superficial LVADI, deeper infections were associated with an increase in mortality (13 vs 46%, p = 0.046). We concluded that early onset with likely in-hospital contamination involved more gram-positive flora, whereas late infection involved more gram-negative flora. Regardless of timing, success of antibacterial treatment was dismal, and infection depth correlated with poorer outcomes.

Narrative medicine applications for patient identity and quality of life in ventricular assist device (VAD) patients.

Patients with advanced heart failure may experience a variety of challenges to their self-identity and quality of life due to their heart condition and treatment by implantation of a ventricular assist device (VAD). These challenges include loss of energy and stamina, loss of independence and autonomy, dependence on loved ones and caregivers for help, strained relationships with family and friends, and uncertainty about treatment outcomes and time of recovery. Narrative Medicine (NM) sessions may help patients to reflect on their situation, rediscover identity, and engage sources of meaning by telling or writing their story. This narrative process may encourage patient resilience and quality of life. The impact of illness and treatment on each patient may be understood more fully in light of each patient's unique identity and life story. Insights from NM visits may also help the treatment team as they assess patients' life situation including sources of support as well as goals and motivation for treatment. This paper provides case reports to illustrate applications of NM in the care of patients with advanced heart failure who are treated with implanted VADs. The cases include use of NM to clarify an elderly patient's motivation and consent for VAD implantation to return to favorite outdoor activities; application of perspectives from NM visits to appreciate a patient's slow but gradual improvement after VAD implantation and strong motivation for recovery; and use of a NM session to help a patient begin to overcome social withdrawal and fear after traumatic post-operative experiences.

Measuring Investment in Learning: Can Electrocardiogram Provide an Indication of Cognitive Effort During Learning?

Heart rate variability (i.e., low frequency:high frequency ratio) was measured to differentiate invested cognitive effort during the acquisition and retention of a novel task. Participants (12 male, M = 25.1 year, SD = 3.6; 12 female, M = 22.8 year, SD = 1.1) were required to produce Braille equivalents of English letter primes on a standardized keyboard in proactive or retroactive conditions (groups, each n = 12). The correct Braille response was either provided before (i.e., proactively) or after (i.e., retroactively) the participant's response. During acquisition, participants in the proactive group demonstrated shorter study time, greater recall success, and reported lower cognitive investment. Participants in the proactive and retroactive groups did not statistically differ in heart rate variability. For retention, the retroactive group showed greater recall success, lower perceived cognitive effort investment, and lower heart rate variability. The results highlight the usefulness of heart rate variability in discriminating the cognitive effort invested for a recently acquired skill.

Mechanical properties and cytotoxicity of a resorbable bioactive implant prepared by rapid prototyping technique.

Bioceramic processing using rapid prototyping technique (RPT) results in a fragile device that requires thermal treatment to improve the mechanical properties. This investigation evaluates the effect of thermal treatment on the mechanical, porosity, and bioactivity properties as well as the cytotoxicity of a porous silica-calcium phosphate nanocomposite (SCPC) implant prepared by RPT. Porous SCPC implant was subject to 3-h treatment at 800°C, 850°C, or 900°C. The compressive strength (s) and modulus of elasticity (E) were doubled when the sintering temperature is raised from 850 to 900°C measuring (s = 15.326 ± 2.95 MPa and E = 1095 ± 164 MPa) after the later treatment. The significant increase in mechanical properties takes place with minimal changes in the surface area and the percentage of pores in the range 1-356 µm. The SCPC implant prepared at 900°C was loaded with rh-BMP-2 and grafted into a segmental defect in the rabbit ulna. Histology analyses showed highly vascularized bone formation inside the defect. Histopathological analyses of the liver, spleen, kidney, heart, and the lung of rabbits grafted with and without SCPC demonstrated healthy tissues with no signs of toxicity or morphology alterations. Results of the study suggest that it is possible to engineering the mechanical properties of the SCPC implant without compromising its bioactivity. The enhanced bone formation inside the porous SCPC facilitated cell-mediated graft resorption and prohibited any accumulation of the material in the body organs.

Bone engineering of the rabbit ulna.

PURPOSE: The purpose of the present preliminary study is to show that a novel 3-dimensional porous silica-calcium phosphate nanocomposite (SCPC) can provide a controlled release of rhBMP-2 and regenerate bone in a load-bearing segmental defect. MATERIALS AND METHODS: A bone replica of the rabbit ulna was created from SCPC powder using rapid prototyping technology. The ceramic bone replica was coated with rhBMP-2 and then implanted into a 10-mm segmental defect created in a rabbit ulna and fixated with a 1-mm titanium adaptation plate. Bone healing was evaluated using computed tomography (CT) scan, histomorphometry, and biomechanical techniques. The release kinetics of rhBMP-2 and the dissolution kinetics were also determined in vitro. Statistical analysis was performed to compare the biomechanical strength of the grafted bone with the contralateral unoperated ulna. RESULTS: After 4 weeks, CT scans showed that the critical size defect had been replaced by newly formed bone. Torsional testing of the ulna after 12 weeks showed restoration of maximum torque and angle at failure. Histological evaluation showed that the regenerated bone had the morphological characteristics of mature bone. SCPC provided a sustained release profile of an effective dose of rhBMP-2 for 14 days. CONCLUSIONS: The SCPC-rhBMP-2 hybrid enhanced bone regeneration in a load-bearing segmental defect in a rabbit ulna. The regenerated bone acquired morphology and mechanical strength typical for natural bone. The enhanced bone formation correlates well with the surface bioactivity and effective release profile of rhBMP-2. The present preliminary study shows the proof of principles that porous, resorbable, bioactive SCPC-rhBMP-2 tissue engineering hybrid can serve as a substitute for autologous bone in load-bearing applications.