Fatty acid profiling of Western Australian pasteurised milk using gas chromatography-mass spectrometry.

The fatty acid composition of Western Australian commercial pasteurised milk was profiled using gas chromatography-mass spectrometry (GC-MS). A total of 31 fatty acids (FA) were identified in the milk samples. The majority of FA were medium-chain fatty acids (MCFA) with 6-13 carbon atoms and long-chain fatty acids (LCFA) with 14-20 carbon atoms. The results of principal component analysis (PCA) showed significant differences in the levels of MCFA and LCFA in the different milk samples. The levels of MCFA and LCFA ranged from 10.09 % to 12.12% and 87.88% to 89.91% of total FA, respectively. C10:0 and C12:0 were the major components of MCFA comprising 3.46% and 4.22% of total FA, while C16:0 and C18:1 (cis 9-octadecenoic acid) represented the majority of LCFA with the levels of 26.18% and 23.34% of total FA, respectively. This study provides new insight into the FA composition of Western Australian pasteurised milk and differences in FA profiles which influence human health.

Voices of chief nursing executives informing a doctor of nursing practice program.

The purpose of this article is to describe the business case framework used to guide doctor of nursing practice (DNP) program enhancements and to discuss methods used to gain chief nurse executives' (CNEs) perspectives for desired curricular and experiential content for doctor of nursing practice nurses in health care system executive roles. Principal results of CNE interview responses were closely aligned to the knowledge, skills and/or attitudes identified by the national leadership organizations. Major conclusions of this article are that curriculum change should include increased emphasis on leadership, implementation science, and translation of evidence into practice methods. Business, information and technology management, policy, and health care law content would also need to be re-balanced to facilitate DNP graduates' health care system level practice.

Bedside Interprofessional Rounding: The View From the Patient's Side of the Bed.

BACKGROUND: Bedside interprofessional rounding is gaining ground as a means to improve collaboration and patient outcomes, yet little is known regarding patients' perceptions of the practice. METHODS: This descriptive study used individual patient interviews to elicit views on interprofessional rounding from 35 patients at a large, urban hospital. RESULTS: The findings identified three major categories: 1) about the rounding process; 2) clinical information; and 3) the impact/value of bedside inter-professional rounding. DISCUSSION: Intentionally eliciting and responding to our patients' views of interprofessional rounding may help us design methods that are patient centered and effective.

PATTERNS OF HEALTHCARE ENCOUNTERS EXPERIENCED BY PATIENTS WITH CHRONIC KIDNEY DISEASE.

BACKGROUND: Patterns of healthcare encounters by patients in each stage of chronic kidney disease (CKD) have not been fully described. OBJECTIVE: This study describes patterns of healthcare resource use by patients with CKD. DESIGN: A retrospective descriptive design was used. PARTICIPANTS: Patients with Stages 1-5 CKD were identified in five existing de-identified healthcare insurance claims databases in the United States using codes from the International Classification of Diseases (ICD-9-CM). MEASUREMENTS: The databases contained more than 23,660,000 claims records from over 11 million subscribers who were continuously enrolled in a single 2014 health plan. All CKD patients' 2014 claims were extracted, yielding 1,987 unique people with 110,594 healthcare encounters. RESULTS: Healthcare resources are used to manage the causes of CKD and its multiple effects on health, and thus the number of healthcare encounters among people with more advanced disease was, as expected, relatively higher. There were more hospitalisations, emergency department visits and specialist encounters in this group. Surprisingly, however, even people in earlier stages of kidney disease experienced a median of 14-17 healthcare encounters during a single calendar year. CONCLUSIONS: Understanding patterns of healthcare encounters provides important information about the transition experiences of patients with CKD. Exploring ways to reduce the risks associated with transitions in care may prevent problems with home medication management, frequent emergency department visits and potentially avoidable hospitalisations.

Creating a faculty community that values curricular assessment and improvement: one DNP program's experience.

Developing faculty ownership of ongoing curricular improvement presents educational and management challenges for schools of nursing, yet little has been published about which components help build a faculty community that values curricular assessment and improvement. The purpose of this case study was to describe key features of and faculty satisfaction with one school of nursing's doctor of nursing practice curricular assessment process, with a description of key considerations for developing an ePortfolio-supported curricular assessment process. ePortfolio matrices were used as a curricular organizing structure for mapping and scoring each completed student assignment to an American Association of Colleges of Nursing Essential descriptor using a rubric that measured evidence of student learning. Faculty satisfaction with the process was also evaluated. First-year results indicated high levels of faculty satisfaction with the assessment process. The initial findings led to four actions for curricular improvement and agreement to continue the assessment process biannually. The curricular assessment was successful in generating faculty satisfaction, identifying needed areas to improve the curriculum, and obtaining faculty agreement to continue the process. A faculty community supportive of curricular assessment is essential to a transformational learning environment that prepares future nursing leaders.

Faculty and organizational characteristics associated with informatics/health information technology adoption in DNP programs.

Nursing informatics/health information technology are key components of graduate nursing education and an accreditation requirement, yet little is known about the extent to which doctor of nursing practice (DNP) curricula include these content domains. The purpose of this descriptive study was to elicit perceptions of DNP program directors relative to (a) whether and how the American Association of Colleges of Nursing's (AACN's) Essential IV standard has been met in their DNP programs; (b) whether the Technology Informatics Guiding Educational Reform Initiative Foundation's Phase II competencies have been integrated in their programs; and (c) the faculty and organizational characteristics associated with the adoption of the AACN's Essential IV. In 2011, an electronic survey was sent to all 138 DNP program directors identified on the AACN Web site with an 81.2% response rate. Findings include variation in whether and how programs have integrated informatics/health information technology content, a lack of informatics-certified and/or master's-prepared faculty, and a perceived lack of faculty awareness of informatics curricular guidelines. DNP program director and dean awareness and support of faculty informatics education, use of informatics competency guidelines, and national policy and stimulus funding support are recommended to promote curricular inclusion and the engagement of nurses in strong informatics practices.

Pregabalin versus placebo in postoperative pain relief of patients' status post photorefractive keratectomy: a double-masked, randomized, prospective study.

PURPOSE: Gabapentinoids are currently being used anecdotally for postoperative pain following photorefractive keratectomy (PRK) despite the lack of evidence. The purpose of this study is to evaluate the effectiveness of pregabalin in mitigating pain after PRK compared to the standard of care. METHODS: One hundred thirty-five patients scheduled for PRK at the Joint Warfighter Refractive Surgery Center in San Antonio, Texas were randomized to receive either oral pregabalin 75 mg twice daily for 5 days or placebo, in addition to the standard pain care regimen. RESULTS: There was no statistically significant difference in the primary outcome of 10% improvement in subjective pain scores between the treatment and placebo groups at any point during the postoperative period, but there was a trend for lower subjective pain scores in the pregabalin group. There was a statistically significant difference in the frequency of rescue pain medications used on postoperative days 1 and 2. The pregabalin group required an average of 1.7 doses of rescue medications on postoperative day 1 versus 2.4 doses in the placebo group, and 1.7 doses versus 2.6 doses on postoperative day 2 (P<0.05). CONCLUSIONS: This study demonstrates that pregabalin may provide an alternative or add-on option to standard narcotics for pain relief after PRK.

Using podcasts to help students apply health informatics concepts: benefits and unintended consequences.

Despite requirements for robust health informatics education, a multitude of educators and policy analysts report that programs are not adequately preparing nurses to handle the bevy of technologies that will be a part of their practice. A series of 14 "Podcasted" exemplars were developed to help graduate online students visualize the application of health informatics concepts in real-world settings and to determine the impact of podcasting on student cognition, engagement, and satisfaction. Although no significant differences in student cognition scores or student engagement were found between course conditions, course satisfaction was significantly higher in Podcasted weeks of the course. Also, student engagement was positively correlated with aspects of course satisfaction and overall cognition scores under both course conditions. This result suggests that student engagement plays an important mediating role in improving cognition. Students' use of podcasting did produce a temporary drop in scores for one group; therefore, more research is needed to understand these unintended consequences. With distance/online education becoming mainstream, it is imperative that faculty deploy and confirm ways to improve student cognition, engagement, and satisfaction.

Affordable Care Act: predictive modeling challenges and opportunities for case management.

PURPOSE/OBJECTIVES: The move to the Accountable Care Organization model of care calls for broad-sweeping structural, operational, and cultural changes in our health care systems. The use of predictive modeling as part of the discharge process is used as a way to highlight just one of the common processes that will need to be transformed to maximize reimbursement under the Accountable Care Organization model. The purpose of this article is to summarize what has been learned about predictive modeling from the population health management industry perspective, to discuss how that knowledge might be applied to discharge planning in the Accountable Care Organization model of patient care, and then to outline how the Accountable Care Organization environment presents various challenges, opportunities, and implications for the case management role. PRIMARY PRACTICE SETTING(S): Hospitals, physician practices. FINDINGS/CONCLUSIONS: The development of predictive models to identify patients at risk for readmission is described and how such models can positively impact the discharge planning process by lowering readmission rates. Examples of the structural, operational, cultural, and case management role changes necessary to maximize the benefits of an Accountable Care Organization are described. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: There is a growing need for advanced practice nurses to fill the leadership, resource management, analytical, informatics-based, and organizational development roles that are sorely needed to advance the Accountable Care Organization model of care. Case managers are well-positioned to lend their expertise to the development efforts, but they will need to be educationally prepared for the many advanced practice roles that will emerge as our nation evolves this new system of health care delivery.

Computerize your infection surveillance for improved patient care--and savings.

Kadlec Medical Center, in Richland, Wash., was able to reduce its nosocomial infection rate by 13 percent and save nearly dollar 576,000 in 15 months by: Working with the infection control department. Developing the business case for infection control initiatives. Conducting a preliminary financial analysis. Sharing data throughout the hospital--not just with the infection control department. Making the adoption of a computerized infection-tracking system a priority.