Innovation and Evidence-Based Decision-Making: Addressing New Graduate Nurse Turnover.

Merger and acquisition activities in health care are increasing in both the number and cumulative value of transactions in recent years, creating new and dynamic pressures on health care systems and current operating environments. These industry shifts, coupled with crises such as the COVID-19 global pandemic, create opportunities for innovation to increase capacity, improve productivity, achieve economies of scale, and positively impact health care quality, safety, access, and cost. However, neither consolidation nor innovation in and of themselves will yield sustainable clinical best practices nor achieve the desired quality, financial, efficiency, retention, or engagement outcomes. This article describes the approach used by one system-level Doctor of Nursing Practice prepared nurse executive to leverage evidence-based decision-making to guide, lead, and support the innovation needed to address first-year new graduate nurse turnover in a multistate not-for-profit health care system.

Methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin in Canada.

This study defines the characteristics of decreasing vancomycin susceptibility in multiple isolates of methicillin-resistant Staphylococcus aureus (MRSA) recovered from a hospitalized patient in Canada over a period of 6 months. The MICs of the isolates increased during therapy with vancomycin. The patient fractured her right hip while in the United States. She was started on treatment with vancomycin. The MICs of successive isolates increased from < or =1 to 4 mg/L over 6 months. Then, an isolate tested at 8 mg/L initially and 4 mg/L with confirmatory E-test (AB BIODISK, Solna, Sweden). One month later, MRSA was still present in her wound, and therapy was changed to linezolid with rifampin. Subsequent cultures were negative for MRSA. Susceptibility testing was performed on the BD Phoenix (Becton Dickinson Diagnostic Systems, Sparks, MD), Dade Microscan (Dade Behring Microscan, Sacramento, CA), Pasco MIC (Becton Dickinson, Sparks, MD), Vitek 2 (bioMerieux, St. Louis, MO), and Sensititre (Trek Diagnostic Systems, Cleveland, OH) systems, and by E-test. Molecular typing (pulsed-field gel electrophoresis [PFGE]) was used to verify the relatedness of the isolates. Transmission electron microscopy (TEM) was used to assess the cell wall thickness of isolates with differing MICs. Population analysis was performed to assess for vancomycin hetero-resistance. MICs of 4 mg/L were only obtained with BD Phoenix, E-test, and broth microdilution. All isolates were identical by PFGE. The most resistant isolate had a thicker cell wall on TEM. Vancomycin hetero-resistance was observed in the resistant isolates. This is the first strain of MRSA with reduced susceptibility to vancomycin reported in Canada. The breakpoints for vancomycin susceptibility have been revised in light of such observations.

Reduced volume PCR amplification reactions using the AmpFlSTR Profiler Plus kit.

The forensic community continues to seek improvements in DNA typing methods on aspects such as sensitivity and efficacy. Reducing the volume of the AmpFlSTR Profiler Plus reagents offered greater sensitivity and improved the chance of obtaining useful results for samples with very low quantities of DNA and multiple source samples. On the downside, amplifications initiated with less than 0.4 ng of DNA exhibited a twofold increase in the standard deviation of peak ratios. This research suggested a twofold approach to analyzing samples. For samples with greater than 0.25 ng of DNA, a 25 microL reaction is appropriate. Samples that did not demonstrate quantifiable results, or that have less than 0.25 ng, can be amplified by drying the sample directly in the PCR tube and amplifying in a 5 microL reaction. The analyst can expect at least limited results with as little as 0.03 ng of DNA in the 5 microL reaction.