Criteria for clinical information technology device selection: what do nurse executives need to know?

Hospital and healthcare's "most wired" organizations were surveyed to determine the evaluative criteria in the selection of bedside devices for clinical documentation. Ranked results of the characteristics are presented. Results can be used to inform nurse executives about selection criteria to consider.

Point-of-care technology supports bedside documentation.

As the conversion to an electronic health record intensifies, the question of which data-entry device works best in what environment and situation is paramount. Specifically, what is the best mix of equipment to purchase and install on clinical units based on staff preferences and budget constraints? The authors discuss their evaluation of stationary personal computers, workshops on wheels, and handheld tablets related to timeliness of data entry and their use of focus groups to ascertain the pros/cons of data-entry devices and staff preferences. An assessment of the implications for costs related to the timeliness of data entry is also presented.

Collegiate rowing crew performance varies by morningness-eveningness.

During adolescence and early adulthood, most humans are predisposed developmentally, both biologically and socially, toward evening/night activity. The morningness-eveningness (M-E) tendency to be an evening-preferring (E-type) rather than a morning-preferring (M-type) or intermediate/neither (N-type) "chronotype" may affect athletic performance at various times of day. This study evaluated M-E effects on rowing performance of an intact, experienced, university club crew with near-daily early morning (0500-0700 hours) and late afternoon (1630-1800 hours) training schedules. The hypothesis tested was that chronotype would modify circadian effects during morning and afternoon performances. Eight men and eight women (mean age 19.6 +/- 1.5 years) were tested in a randomized, counterbalanced design. A standard qualifying 2000-m ergometer rowing sprint and a nonroutine standing broad jump task were measured during early morning and late afternoon, separated by 3 days of rest. Each subject's chronotype was determined using two standard self-rating M-E scales, resulting in eight E-type (three women/five men), four M-type (two women/two men), and four N-type (three women/one man) subjects. The rowing results show that E-type and N-type subjects did not differ between morning and afternoon rowing performances, whereas M-type subjects rowed significantly faster in the morning. In contrast, the standing broad jump showed no consistent time-of-day or chronotype effect. These findings suggest that basic performance timing in young athletes is determined to some extent by naturally occurring M-E predispositions. Further, modification of time-of-day influences may be possible by routine practice at the same time each day, as was suggested here by the absence of evening superiority in performances. Understanding their personal M-E tendencies could allow young athletes to arrange training schedules at specific times of day to help counteract any natural circadian influences that might work against their performance.

Nursing care after a shoulder arthroplasty.

Shoulder arthroplasties are not performed as often as hip and knee arthroplasties. Therefore, the comfort level of caring for these patients may vary amongst nurses. This article will discuss the various types of shoulder arthroplasties, and the postoperative care required for these patients including physical assessment skills, sling management, postural maintenance, activity and range of motion restrictions, and pain management. In addition, the need for a multidisciplinary team approach and discharge planning are discussed. Excellent nursing care, a multidisciplinary approach, and thorough patient education will add to the success of the surgical outcome.

A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up.

BACKGROUND: Arthroscopic treatment of anterior shoulder dislocation has become possible through improvements in instruments and techniques. OBJECTIVE: To prospectively evaluate results of arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with histories of shoulder dislocation and an anterior-inferior labral tear at the time of diagnostic arthroscopy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of 85 patients (70 men, 15 women; mean age, 26 years) with Bankart lesions were treated with arthroscopic repair using suture anchors; 18 patients (27%) had extension of the labral injury into the superior labrum affecting some or all of the biceps anchor. Anchors were loaded with no. 2 nonabsorbable braided suture and placed 2 mm into the edge of the glenoid surface. A low anterior (5-o'clock) portal through the subscapularis tendon was used in all patients; 72 patients were evaluated at a minimum of 2 years postoperatively (mean, 46 months). RESULTS: Seven patients (10%) experienced recurrent instability after repair. Four patients had redislocations; 3 experienced recurrent subluxations. One patient had pain with the apprehension test without a clear history of recurrent instability. Of 18 collision athletes, 2 had dislocations at 22 and 60 months postoperatively. There were no complications, including no neurologic deficits. Clinical strength testing of the subscapularis muscle was normal in all patients. The mean Rowe score was 88 of 100 points, with 90% excellent or good results. Simple Shoulder Test responses improved from 66% positive preoperatively to 88% positive postoperatively. The American Shoulder and Elbow Surgeons scoring index averaged 92 of 100 points postoperatively. Pain analog scales improved from 5.5 preoperatively to 0.35 postoperatively on a 10-point scale. SF-12 scores improved for physical function. Patient satisfaction was rated 8.9 on a 10-point visual analog scale. CONCLUSION: Bankart repairs performed arthroscopically using properly implanted suture anchors and nonabsorbable sutures and in which associated pathoanatomy is addressed demonstrate low recurrence rates (10%) similar to historical open controls.

Seasonal rhythms of menarche in the United States: correlates to menarcheal age, birth age, and birth month.

PURPOSE: To examine the seasonality of menarche in a large sample of women from the United States. METHODS: Retrospective data were collected on month of birth and menarche, age of menarche, and latitude and altitude of residence from a sample of approximately 3,000 U.S. women from the TREMIN Research Program and from a college student population. RESULTS: Monthly analyses using observed (O) to expected (E) ratios indicated a peak frequency of menarche in July (1.45) and January (1.19) and troughs in February (0.75) and May (0.79). Collapsing the data into seasons also revealed summer and winter peaks. Participants from a younger cohort (born after 1970) had an earlier age of menarche than participants from an older cohort (born before 1970). Older cohort participants also had a more pronounced December-January frequency peak and younger cohort participants had a more pronounced July frequency peak. Older cohort participants exhibited more variability in menarcheal age as a function of menarche month and birth month. Late-maturing participants (>14 years) had a larger December peak of menarche frequencies. Spring-born participants exhibited less seasonality to their menarche. Month of birth was not significantly associated with month of menarche; however, fewer cases than expected occurred 3 months after the birth month and more cases than expected occurred 6 months after the birth month. Age of menarche and monthly distribution of menarche did not vary according to latitude or altitude. CONCLUSIONS: Menarche seasonality is suggested to be a multifactor process mediated by the most prominent seasonal time cue. Attention to these cues that have been hypothesized to contribute to menarche seasonality (e.g., stress or the photoperiod) may have practical implications for women's health, given some of the risks associated with early menarche.

Patologia do trabalho

Aborda questöes de saúde-doença, faz uma exposiçäo dos temas mais atuais como a adaptaçäo e suas implicaçöes, os problemas ligados à higiene ocupacional, à seleçäo de instrumentos de pesquisa, bem como às principais propostas para a organizaçäo e intervençäo em sistemas de turnos