Patient reported outcome measures of bilateral reverse total shoulder arthroplasty compared to bilateral anatomic total shoulder arthroplasty.

The purpose of this study was to compare patient reported functional outcomes following bilateral aTSA vs rTSA. A retrospective review was conducted on twenty-six pateints who underwent staged bilateral aTSA or rTSA, with a minimum of 2 years follow up. Thirteen patients were included in each group, and patient assessed functional outcomes were measured using the PENN Score, ASES, SST, and SF-12. No statistically significant differences were found between the two groups for all functional outcome scores, patient satisfaction, or SF-12. These findings suggest that patients undergoing bilateral rTSA can expect functional outcomes similar to those obtained after bilateral aTSA. None of the authors involved in the work nor any of the author's institutions at any time received payment or services from a third party for any aspect of the submitted work and have no conflicts of interest to disclose.

The 360-degree evaluation model: A method for assessing competency in graduate nursing students. A pilot research study.

BACKGROUND: The 360 Degree Evaluation Model is one means to provide a comprehensive view of clinical competency and readiness for progression in an online nursing program. OBJECTIVES: This pilot project aimed to evaluate the effectiveness of implementing a 360 Degree Evaluation of clinical competency of graduate advanced practice nursing students. DESIGN: The 360 Degree Evaluation, adapted from corporate industry, encompasses assessment of student knowledge, skills, behaviors and attitudes and validates student's progression from novice to competent. SETTINGS: Cohort of advanced practice nursing students in four progressive clinical semesters. PARTICIPANTS: Graduate advanced practice nursing students (N = 54). METHODS: Descriptive statistics and Jonckheere's Trend Test were used to evaluate OSCE's scores from graded rubric, standardized patient survey scores, student reflection and preceptor evaluation. RESULTS: We identified all students passed the four OSCEs during a first attempt or second attempt. Scaffolding OSCE's over time allowed faculty to identify cohort weakness and create subsequent learning opportunities. Standardized patients' evaluation of the students' performance in the domains of knowledge, skills and attitudes, showed high scores of 96% in all OSCEs. Students' self-reflection comments were a mix of strengths and weaknesses in their self-evaluation, demonstrating themes as students progressed. Preceptor evaluation scores revealed the largest increase in knowledge and learning skills (NONPF domain 1), from an aggregate average of 90% in the first clinical course, to an average of 95%. CONCLUSIONS: The 360 Degree Evaluation Model provided a comprehensive evaluation of the student and critical information for the faculty ensuring individual student and cohort data and ability to analyze cohort themes.

Home Therapy to Reduce Office Visits for Patients with Chronic Kidney Disease and Anemia.

Anemia is a common complication of chronic kidney disease (CKD) and a predictor of increased mortality. This project integrated erythropoietin-stimulating agent (ESA) with CKD care under one practice setting, co-managing anemia with CKD while reducing frequency of office visits in a rural setting. Patients self-administered their weekly dosage of erythropoietin with monthly follow-ups. As a result, office visits decreased by 56% for patients with CKD Stage 4 and by 54% for patients with CKD Stage 5.

Integrating a Question Prompt List on an Inpatient Oncology Unit to Increase Prognostic Awareness.

BACKGROUND: Many patients with incurable cancer do not accurately understand their prognosis, which can lead to aggressive and, often, futile treatment. Improved prognostic awareness can help patients to appropriately de-escalate aggressive treatment sooner in an illness trajectory. OBJECTIVES: The purpose of this article is to introduce a patient-initiated discussion aid (question prompt list) on an oncology unit to increase prognostic awareness by promoting patient-provider dialogue, which could lead to limitation of life-sustaining treatments at the end of life and increased do-not-resuscitate (DNR) orders and hospice referrals. METHODS: Medical records of consecutively admitted patients with a solid malignancy who were urgently admitted to the inpatient setting were reviewed for three months to determine the percentage of DNR orders and referrals to hospice care. After inclusion of the communication aid in admission packets, records of consecutively admitted patients to the inpatient setting were reviewed for three months to reassess the percentage of DNR orders and referrals to hospice care. FINDINGS: An increase was seen in the percentage of patients with active DNR orders and in hospice referrals after a discussion aid was included in admission packets.

Implementation of Recovery Programming on an Inpatient Acute Psychiatric Unit and Its Impact on Readmission.

BACKGROUND: Recovery-oriented models of care are evidence based and have been shown to improve patient satisfaction and outcomes as well as decrease the percentage of readmissions to inpatient psychiatric units. METHODS: This quality improvement project was implemented on a 16-bed inpatient adult mental health unit in a Veterans Affairs Medical Center. Percentages of readmissions were compared throughout the course of implementation of the recovery model. Readmissions during the months of July-September were tabulated over 3 subsequent years and compared readmission percentages before recovery implementation, during the early stage of recovery implementation, and finally, during ongoing recovery implementation. RESULTS: A decrease in readmission percentages was seen with implementation of recovery-oriented care when comparing the same 3-month period over 3 years. CONCLUSION: After implementation of recovery-oriented care measures, there was a decrease in percentage of readmissions to the unit. In addition, this decrease was sustained and was shown to improve over time as recovery-oriented programming was further developed on the unit. These data suggest that Veterans Affairs Medical Centers should consider adding tools and procedures to successfully implement recovery programming on inpatient units and efforts should include direct involvement of patients in their own recovery journey, revision of policies and procedures to reflect the importance of recovery, thorough training of frontline staff regarding recovery principles, and transfer of recovery information directly from inpatient units to outpatient providers.

Impressions of pharmacogenomic testing among Certified Registered Nurse Anesthetists: a mixed-method study.

AIM: Pharmacogenomic testing is useful in helping to predict and explain patient responsiveness to medication. In clinical practice, the use of pharmacogenomic testing has been shown to help reduce adverse drugs events and increase patient satisfaction with their healthcare. Prior to a test being useful, it must have clinical utility. There is a gap in the literature about the perceived clinical utility of pharmacogenomic testing among anesthesia providers. METHODS: This qualitative-quantitative sequential mixed-method study used focused interviews to formulate probes for a quantitative survey aimed at quantifying the perceptions of anesthesia providers about pharmacogenomic testing. RESULTS: The results indicate anesthesia providers do not have enough knowledge about pharmacogenomic testing for it to be considered clinically useful in anesthesia practice. CONCLUSION: Although outcomes data indicate pharmacogenomic testing can help predict outcomes, anesthesia providers do not have enough knowledge and have concerns about the ethical implications of pharmacogenomic testing.

Improving Follow-Up for Failed Newborn Hearing Screening in Emirati Infants.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

The influence of body mass index on clinical short-term outcomes in robotic colorectal surgery.

BACKGROUND: Robotic surgery has been developed to address the technical limitations of laparoscopic surgery and might result in similar outcomes for patients with low and high body mass index (BMI). METHODS: Demographic, peri-operative data and surrogate oncologic markers for colorectal cancer of patients that underwent robotic colorectal procedures were collected in a prospective database and analyzed. RESULTS: 103 consecutive patients (36 normal-weight, 33 overweight, 34 obese) underwent robotic colorectal surgery from 11/2011 to 05/2012. While operating room (OR) time was longer for the obese patients (123.4 vs 137.9 and 154.7 min), results for estimated blood loss (104.2 vs 153 and 155.9 mL), conversions (2.8 vs 6.1 and 5.9%), complications (19.4 vs 21.2 and 32.4%), re-admissions (11.1 vs 112.1 and 20.6) and mortality (0% for all) were comparable. BMI did not affect the surrogate markers in patients with malignancies. CONCLUSIONS: Data demonstrates that patient BMI does not have a significant impact on short-term clinical outcomes during robotic colorectal surgery. Copyright © 2015 John Wiley & Sons, Ltd.

Depression Screening in Chronic Disease Management: A Worksite Health Promotion Initiative.

This pilot project aimed to improve depression symptoms and quality-of-life measures for individuals in a worksite disease management program. Two hundred forty-three individuals were invited to participate, out of which 69 enrolled. The participants had a history of diabetes, hypertension, or hyperlipidemia, and demonstrated depression using the Patient Health Questionnaire-9 (PHQ-9). The project consisted of counseling sessions provided every 2 to 4 weeks by a family nurse practitioner. PHQ-9 scores and those of an instrument that measures quality of life, the Veteran's Rand-12 (VR-12), were compared pre-intervention and post-intervention to evaluate the effectiveness of the project. PHQ-9 and VR-12 Mental Health Component (MHC) scores improved significantly after 3 months of nurse practitioner-led individual counseling sessions. This project demonstrated that depression screening and therapeutic management, facilitated by a nurse practitioner, can improve depression and perceived quality of life in individuals with hypertension, hyperlipidemia, or type 2 diabetes.

Tranexamic acid decreases blood loss after total shoulder arthroplasty.

BACKGROUND: Tranexamic acid (TXA) significantly decreases blood loss and transfusion rates after total hip and total knee arthroplasty. The purpose of this study was to determine the effects of intravenous TXA on blood loss and patient outcomes after total shoulder arthroplasty (TSA). METHODS: TXA was used in 106 consecutive patients undergoing primary anatomic and reverse TSA with a dose of 20 mg/kg intravenously (TXA group) and compared with the previous consecutive 88 patients without TXA (non-TXA group). All patients had a blood sample drawn for a hemoglobin and hematocrit determination the morning after surgery. Analysis of variance and χ(2) techniques were used to analyze study hypotheses. RESULTS: Statistically significant differences in both hemoglobin loss (TXA group Δ = 2.13 vs. non-TXA group Δ = 2.63; P = .01) and hematocrit loss (TXA group Δ = 6.4 vs. non-TXA group Δ = 8.14; P < .01) were seen in the TXA group compared with the non-TXA group. In patients receiving TXA, there were statistically significant decreases in the time spent in the recovery room (mean, TXA group 69 minutes vs. non-TXA group 87 minutes; P < .02) and total length of hospitalization (mean, TXA group 1.18 days vs. non-TXA group 1.4 days; P = .01). Two patients in the TXA group received a blood transfusion, whereas 6 patients in the non-TXA group did. CONCLUSIONS: TXA 20 mg/kg intravenously given just before primary anatomic and reverse TSA results in statistically significant reductions in blood loss. Patients spent 21% less time in the recovery room and had a 16% shorter hospitalization, resulting in financial savings for the hospital.

Expanding Simulation Capacity: Senior-Level Students as Teachers.

BACKGROUND: The effectiveness of using senior-level nursing students as teachers to junior-level students in simulated learning was examined in a prelicensure nursing program. Simulation requires considerable financial resources in faculty time and effort. It was theorized that using senior students as teachers for junior students in peer-assisted simulation for learning health assessment clinical skills would offer an equally effective learning experience as faculty instructors. METHOD: A total of 60 junior-level students were randomized into a simulated learning experience taught by 20 senior-level students or nursing faculty. RESULTS: Evaluation of junior students' clinical performance, postsimulation debriefing assessment, and satisfaction with the simulation learning experience indicated that senior nursing students were equally effective as faculty simulation instructors. CONCLUSION: Findings suggest that the Senior Students as Teachers program, using the train-the-trainer model, was successful in preparing students as simulation instructors and has the potential for reducing faculty time and cost, as well as enhance student peer-to-peer learning.

In Lumbar Fusion Patients, How Does Establishing a Comfort Function Goal Preoperatively Impact Postoperative Pain Scores?

The purpose of this feasibility study was to determine the impact of establishing a comfort function goal preoperatively on postoperative pain scores and opiate requirements in lumbar fusion patients. A comfort function goal is defined as the pain score identified by the patient describing the level of pain tolerance to participate in healing activities such as deep breathing, ambulation and participation in activities of daily living. The design was prospective, nonrandomized, intervention group (n = 30) compared with retrospective chart review as control group (n = 30). Sample included patients scheduled for routine lumbar fusion in an urban southeastern hospital. The study intervention established a comfort function goal during a routine preoperative patient education class. No significant difference in pain score or opiate requirement was found for these data. However, a fundamental clinical question arose surrounding opiate requirements and dosing management. In our hospital, the norm for postoperative pain management is to categorize pain scores as mild (1-3), moderate (4-6), and severe (7-10) pain. Physician orders commonly use this differential to order opiate dose ranges. In this sample, the mean pain score for the intervention group at home is 5.8 and the mean comfort function goal is 4.9. Based on normative categories of pain scores, if a patient's baseline of tolerable pain is 4.9, this has potential impact on clinician responses to managing pain, as 4.9-5.8 is, for this patient, perhaps a mild range of pain, not moderate. If a patient reports a pain score of 7, and their norm is 5.8, the delta is only 1.2. Does this imply that the patient is experiencing mild or severe pain? Does the nurse deliver a dose of pain medication that is in the mild or severe dose range?

Shared Decision Aids: Increasing Patient Acceptance of Long-Acting Reversible Contraception.

Unintended pregnancies are an important public health issue. Long-acting reversible contraceptive methods (LARCs) are reliable, safe, highly effective methods for most women; however they are underutilized in the United States. Shared decision aids were added to usual care in five public health family planning clinics in the Southeastern United States, staffed by advance practice nurses and registered nurses. All five sites showed an increase in the use of LARCs during the time period that shared decision aids were used (results statistically significant to p < 0.001). It is important for women to make informed choices about contraception, and shared decision aids can be utilized to support this decision making. This resource has been adopted for statewide use in all public health clinics, and implications for practice suggest that the use of shared decision aids is an effective method to support informed patient decision making and acceptance of LARC methods of contraception.

Preventing ventilator-associated events: complying with evidence-based practice.

The leading cause of death due to health care-associated infections is ventilator-associated pneumonia (VAP). The lack of clarity in the definition of VAP has made it difficult to execute and evaluate the effectiveness of prevention strategies. Beginning in 2013, hospitals were expected to implement a new surveillance definition algorithm to identify ventilator-associated events (VAEs). The Institute for Healthcare Improvement recommended the use of the Ventilator Care Bundle as part of an initiative to decrease the incidence of VAP. This article outlines the results of a quality improvement project that was conducted to address this recommendation, improve current staff knowledge, identify gaps in practice, and determine the rate of compliance with prevention strategies. The major findings of this project also exposed limitations of the electronic medical record system, and suggested enhancements, which would promote the VAP Bundle initiatives, facilitate documentation, and permit straightforward data collection.

Outcomes of a quality improvement project implementing stroke discharge advocacy to reduce 30-day readmission rates.

The purpose of this quality improvement project was to determine whether use of aspects of a transitional care model by nurse navigators would affect 30-day readmission rates in hospitalized ischemic stroke patients discharged home with self-care. Thirty-day readmission rates and emergency department (ED) visits were compared before, during, and after the implementation of the revised discharge process. Comparative analysis demonstrated reductions in readmissions and in ED visits. Thirty-day readmission rates to our hospital decreased from 9.39% to 3.24% when comparing pre- with postintervention data. Thirty-day ED visit rates to all state hospitals decreased from 16.36% to 12.08% when comparing pre- with postintervention data.

An evidence-based parenting intervention with inner-city teen mothers.

The consequences of teen pregnancy have a substantial negative impact on both the teen mother and her child. Recent evidence clearly supports parenting education as the most effective means for improving adolescent parenting skills. This study evaluated the effectiveness of a school-based program using an evidence-based educational intervention to improve parenting style in high school teen mothers. Teen mothers, from 15 to 18 years of age, in a Title 1 high school were recruited from the Early Head Start program. Two groups of teens (N = 10) completed a pre-parenting style survey, enrolled in an 8- or 12-week group educational session, and completed a post-parenting style survey. While quantitative data did not yield a change in parenting style, qualitative findings highlighted a strong need for teens to "tell their story" and to share personal experiences related to parenting. These findings lend support for the role of parenting educational interventions in high schools with teens at high risk for pregnancy.

Moving toward greater diversity: a review of interventions to increase diversity in nursing education.

PURPOSE: To report the results of a comprehensive review of interventions used by nursing programs to increase the success of underrepresented minority nursing students graduating from prelicensure programs. DESIGN: This review used the five stages of review methodology described but Whittemore and Knafl to extract data, summarize, and synthesize findings of 11 studies included in this review. Intervention strategies were organized using concepts of Jeffreys's Nursing Undergraduate Retention and Success model. FINDINGS: Interventions were designed to improve recruitment, retention, and academic performance through a variety of innovative activities. CONCLUSIONS: This review highlighted the necessity for future researchers to report in-depth and detailed information about the implementation of interventions. Comprehensive information about the program, faculty, setting, interventions, and challenges faced during implementation were often missing from these reports, making replication difficult.

Perceived barriers to success for minority nursing students: an integrative review.

The objective of this paper was to identify barriers to successful program completion faced by underrepresented minority nursing students. This paper reveals that minority nursing student's face multiple barriers to success including lack of financial support, inadequate emotional and moral support, as well as insufficient academic advising, program mentoring, technical support, and professional socialization. An additional theme-a resolve to succeed in spite of the identified barriers-was identified. This body of literature focuses solely on successful minority students' experiences, revealing a significant gap in the research. The findings of this paper highlight the need to create and maintain nursing programs capable of aggressively supporting minority student needs. Recommendations for future research are included.

Online coaching for a lower limb physical activity program for individuals at home with a history of venous ulcers.

The goal of this preliminary study was to test a structured home-based chair physical activity (PA) intervention, using a "live" coach on the feasibility of using the Internet to work with patients who had a history of leg ulcers. A 10- to 15-minute lower limb PA protocol using resistance tubing and foot pushing and peddling devices were used in the study while the coach watched patients perform the activities three times over a 7-day period. The Internet for "live" coaching was found to be feasible and patient-acceptable.