Use of a Pediatric Cardiovascular Nursing Consortium for Development and Evaluation of Quality Measures: The C4-MNP Experience.

UNLABELLED: The evidence linking nursing care and patient outcomes has been globally demonstrated. Thus, it is time for translation and application of this evidence to robust measurement that uniquely demonstrates the value of nursing care and the characteristics of the nursing workforce that contribute to optimal patient outcomes. OBJECTIVE: The aim of this study was to identify and develop standardized measures representative of pediatric nursing care of the cardiovascular patient for benchmarking within freestanding children's hospitals. METHODS: Using a consensus-based approach, the Consortium of Congenital Cardiac Care- Measurement of Nursing Practice (C4-MNP) members developed quality measures within working groups and then individually critiqued all drafted measures. Final draft measures were then independently reviewed and critiqued by an external nursing quality measurement committee. The final quality measures were also made available to a national parent support group for feedback. OUTCOMES: The development process used by C4-MNP resulted in 10 measures eligible for testing across freestanding children's hospitals. Employing a collaborative consensus-based method plus implementing the criteria of the National Quality Forum and external vetting period provided a strong framework for the development and evaluation of standardized measures. NEXT STEPS: The Consortium will continue with implementation and testing of each measure in 9 of our 28 collaborating centers. This activity will support initial development of benchmarks and evaluation of the association of the measures with patient outcomes.

Measurement of Quality of Nursing Practice in Congenital Cardiac Care.

BACKGROUND: The impact of nursing care on patients' outcomes has been demonstrated in adult and pediatric settings. However, limited attention has been given to standardized measurement of pediatric nursing care. A collaborative group, the Consortium for Congenital Cardiac Care Measurement of Nursing Practice, was formed to address this gap. The purpose of this study was to assess the current state of measurement of the quality of pediatric cardiovascular nursing in freestanding children's hospitals across the United States. METHODS: A qualitative descriptive design was used to assess the state of measurement of nursing care from the perspective of experts in pediatric cardiovascular nursing. Nurse leaders from 20 sites participated in audiotaped phone interviews. The data were analyzed by using conventional content analysis. RESULTS: Each level of data coding was increasingly comprehensive. Guided by Donabedian's quality framework of structure, process, and outcome, 2 encompassing patterns emerged: (1) structure and process of health care delivery and (2) structure and process of evaluation of care. Similarities in the structure of health care delivery included program expansion and subsequent hiring of nurses with a bachelor of science in nursing and experienced nurses to provide safety and optimal outcomes for patients. Programs varied in how they evaluated care in terms of structure, measurement, collection and dissemination of data. CONCLUSION: External factors and response to internal processes of health care delivery were similar in different programs; evaluation was more varied. Seven opportunities for measurement that address both structure and process of nursing care were identified to be developed as benchmarks.

Vitamin D3 therapy corrects the tissue sensitivity to angiotensin ii akin to the action of a converting enzyme inhibitor in obese hypertensives: an interventional study.

CONTEXT: Vitamin D deficiency and obesity are associated with increased tissue renin-angiotensin system (RAS) activity. OBJECTIVE: The objective of the study was to evaluate whether vitamin D(3) therapy in obesity reduces tissue-RAS activity, as indicated by an increase in tissue sensitivity to angiotensin II (AngII). PARTICIPANTS: Participants included obese subjects with hypertension and 25-hydroxyvitamin D less than 25 ng/ml. DESIGN: Subjects were studied before and after 1 month of vitamin D(3) 15,000 IU/d, while in dietary sodium balance, and off all interfering medications. Fourteen subjects successfully completed all study procedures. SETTING: The study was conducted at a clinical research center. OUTCOME MEASURES: At each study visit, tissue sensitivity to AngII was assessed by measuring renal plasma flow (RPF), mean arterial pressure (MAP), and adrenal secretion of aldosterone during an infusion of AngII. Subjects were then given captopril, and a second AngII infusion to evaluate the effect of captopril on tissue-RAS activity. RESULTS: Vitamin D(3) therapy increased 25-hydroxyvitamin D (18 to 52 ng/ml) and basal RPF (+5%) and lowered supine MAP (-3%) (all P < 0.01). There was a greater decline in RPF and higher stimulation of aldosterone with AngII infusion after vitamin D(3) therapy (both P < 0.05). As anticipated, captopril increased the renal-vascular, MAP, and adrenal sensitivity to AngII, but this effect was much smaller after vitamin D(3) therapy, indicating that vitamin D(3) therapy corrected the tissue sensitivity to AngII akin to captopril. CONCLUSIONS: Vitamin D(3) therapy in obese hypertensives modified RPF, MAP, and tissue sensitivity to AngII similar to converting enzyme inhibition. Whether chronic vitamin D(3) therapy abrogates the development of diseases associated with excess RAS activity warrants investigation.

Influence of dietary sodium modulation on electrocardiographic voltage criteria for left ventricular hypertrophy in normotensive individuals.

OBJECTIVE: Dietary sodium intake and left ventricular hypertrophy (LVH) on electrocardiogram (ECG) are both independent determinants of cardiovascular risk. Prior studies demonstrated that acute dietary sodium modulation significantly altered LVH-specific ECG voltage in hypertensive individuals, thus modifying cardiovascular risk prediction; but whether this phenomenon exists in normotensive individuals is not known. We evaluated the influence of dietary sodium intake on ECG voltage and ECG criteria for LVH in normotensive individuals. METHODS: Retrospective evaluation of ECGs of healthy normotensive individuals (n = 39) who were prospectively randomized to a dietary study protocol of 1 week of high-sodium diet (>200 mmol of sodium per day) and 1 week of low-sodium diet (<10 mmol/d) was conducted. Electrocardiogram voltage amplitudes and biochemical assessments were performed at the end of each dietary intervention. RESULTS: As expected, blood pressure declined and measures of circulating renin-angiotensin-aldosterone system activity rose significantly with low-sodium diet. No significant changes in specific LVH voltage criteria or overall precordial or limb lead ECG voltage amplitudes were detected between diets. CONCLUSION: Although immediate dietary sodium modulation has been shown to significantly alter LVH-specific ECG voltage and the detection of LVH in hypertensive individuals, dietary sodium intake did not influence ECG voltage in normotensive individuals. Healthy normotensive individuals may exhibit adaptive measures that dampen ECG voltage fluctuations in response to dietary sodium modulation. More specific cardiac imaging studies may provide additional insight into this observation and the influence of dietary sodium in cardiac health.

Learning objects: resources for instruction.

OBJECTIVE: Upon completion of this article, the reader will be able to describe learning objects (LOs) and discuss their use in clinical laboratory sciences instruction. DESIGN: Through a questionnaire, educators evaluated clinical laboratory sciences-related LOs for accessibility, usability and instructional qualities. SETTING: LOs were presented on a password-accessed website. Evaluations were completed on the website. PARTICIPANTS: Nine educators participated in the evaluation. INTERVENTIONS: The LOs were made available to participants for use in their own instructional material. MAIN OUTCOME MEASURE(S): The evaluation measured educators' interest in and perceived usefulness of LOs in clinical laboratory sciences curriculum. RESULTS: On a scale of one to five with one equal to poor and five equal to excellent, participants rated LOs as accessible (4.68) and usable (4.61). Ninety-eight percent stated that they would use LOs in their curriculum. Fifty-seven percent stated that they could attribute improved learning performance on student exposure to LOs. CONCLUSION: LOs are useful, relevant, and time-saving resources to clinical laboratory sciences instruction.

A qualitative assessment of systematic instructional design training by CLS faculty members.

OBJECTIVE: To determine the perceived value clinical laboratory science (CLS) faculty members gave to their participation in workshops on the use of a modified systematic instruction design (SID) model to develop curriculum and on-line courses. DESIGN: A survey assessing the perceived value of SID training was sent to 27 CLS faculty members. The survey asked the respondents to assess the value of the training that they received in developing their skills in Web-based, distance learning course development and teaching, and expanding their skills in traditional course development and teaching. The eight components of SID were listed and the respondents rated each component as to its value to them on a 5-point Likert scale of 5 = very valuable to 1 = not very valuable. In addition to rating the value of each SID component, the respondents were asked if they would like more training in any of the eight components. RESULTS: A majority of the 18 respondents (67%) reported that the training in SID was valuable to them. A strong majority of the respondents indicated that their training in goal and instructional analyses (96%), media selection (94%), and aligning objectives, assessments, and instructional strategies (94%) were valuable to their distance education programs and their traditional teaching skills. CONCLUSION: Faculty members who actively participated in SID training valued their new skills in developing distance education courses as well as improving their traditional teaching activities. Research is needed on the effect these new teaching skills have on student learning.

Abnormal cervicovaginal smears due to endometriosis: a continuing problem.

Endometriosis may be challenging when identified on cervicovaginal smears (CVS), leading to an incorrect interpretation of high-grade squamous intraepithelial lesion (HSIL), or atypical glandular cells of undetermined significance (AGUS) including adenocarcinoma in situ (AIS). Awareness of cervical endometriosis, particularly in predisposed patients, is crucial for a correct diagnosis. While cervical endometriosis has been reported to be a diagnostic pitfall of glandular abnormalities, its characteristic features are still not well-established. This may partially be attributed to the varied cytomorphologic features endometriosis shows, depending on menstrual cycle hormonal changes. We describe our experience with three examples where CVS were interpreted as either AGUS or HSIL, which led to a hysterectomy in 2 of 3 patients. Cervical endometriosis needs to be considered with other well-known benign conditions that mimic glandular abnormalities, including cervicitis, tubal metaplasia, lower uterine segment sampling, and microglandular hyperplasia. Published series and our own experience lead us to suggest that these smears will continue to present diagnostic difficulties.