Using new careers in nursing research findings to develop an evidence-based pre-entry immersion program.

BACKGROUND: New Careers In Nursing (NCIN) data analysis results were used to inform the development of The Bridge to Nursing Success Program (Bridge). NCIN data revealed that participation in a pre-entry immersion program (PIP) was associated with higher rates of retention and graduation. PURPOSE: The purpose of this article is to 1). describe the findings of the NCIN Scholarship Program in relation to pre-entry immersion (PIP) programs. 2). Discuss and report the development of The Bridge to Nursing Success Program 3). Report results of the Bridgeto Nursing Success Program. METHOD: The Bridge to Nursing Success Program (Bridge Program) was developed based on NCIN findings. Two Bridge cohorts (N = 44) of accelerated nursing students participated in a nine-day pre-immersion program (PIP) that included face to face classes and discussions. Post program surveys were administered to assess helpfulness of program content. FINDINGS: Student evaluations revealed an overwhelmingly positive response to the program. Both Bridge participants and non-Bridge participants performed equally through the first semester. Students who participated in the Bridge Program were less likely to fail a course in the first semester, and Bridge participants were six times more likely to be successful in the pathophysiology course. DISCUSSION: The study provides an evidence-based PIP model that offers academic support and coping strategies prior to an accelerated nursing program. Long-term follow up of the participating cohorts may reveal whether there is a relationship to this PIP program and persistence through to graduation.

Acute delirium: differentiation and care.

The health care costs for patients with delirium were estimated to be more than double the costs for patients without delirium and potentially exceeded the costs for falls, diabetes mellitus, and hip fractures; yet the fluctuating nature of the condition makes it a difficult condition for health professionals to recognize and treat. The key, then, is in recognition and prevention.

Double-blind, placebo-controlled study of amantadine hydrochloride in the treatment of children with autistic disorder.

OBJECTIVE: To test the hypothesis that amantadine hydrochloride is a safe and effective treatment for behavioral disturbances--for example, hyperactivity and irritability--in children with autism. METHOD: Thirty-nine subjects (intent to treat; 5-19 years old; IQ > 35) had autism diagnosed according to DSM-IV and ICD-10 criteria using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule-Generic. The Aberrant Behavior Checklist-Community Version (ABC-CV) and Clinical Global Impressions (CGI) scale were used as outcome variables. After a 1-week, single-blind placebo run-in, patients received a single daily dose of amantadine (2.5 mg/kg per day) or placebo for the next week, and then bid dosing (5.0 mg/kg per day) for the subsequent 3 weeks. RESULTS: When assessed on the basis of parent-rated ABC-CV ratings of irritability and hyperactivity, the mean placebo response rate was 37% versus amantadine at 47% (not significant). However, in the amantadine-treated group there were statistically significant improvements in absolute changes in clinician-rated ABC-CVs for hyperactivity (amantadine -6.4 versus placebo -2.1; p = .046) and inappropriate speech (-1.9 versus 0.4; p = .008). CGI scale ratings were higher in the amantadine group: 53% improved versus 25% (p = .076). Amantadine was well tolerated. CONCLUSIONS: Parents did not report statistically significant behavioral change with amantadine. However, clinician-rated improvements in behavioral ratings following treatment with amantadine suggest that further studies with this or other drugs acting on the glutamatergic system are warranted. The design of these and similar drug trials in children with autistic disorder must take into account the possibility of a large placebo response.

Nosocomial enterococcal infections in children.

OBJECTIVES: To identify factors that are associated with an increased risk of nosocomial enterococcal infection in children. METHODS: A matched case-control study was conducted between January 1989 and July 1993 at the Children's National Medical Center, Washington DC. One control patient for each case was identified. Control patients did not have nosocomial enterococcal infections and were matched with cases on the basis of age and time of admission closest to the case within a three-month period. Data were collected from systematic review of patient medical records. One hundred and one study patients (cases) were matched with 101 control patients. A case was defined as a patient with enterococcal infection who met the Centers for Disease Control and Prevention criteria for nosocomial infection. Microbiology methods included isolation, identification, and antimicrobial susceptibility testing of enterococci from clinical specimens. RESULTS: Risk factors associated with nosocomial enterococcal infections were determined by multiple conditional logistic regression analyses of the cases and controls. Factors identified were placement of a central line, gastrointestinal tract pathology, and administration of multiple antimicrobial agents. The median duration of antimicrobial therapy prior to diagnosis of nosocomial enterococcal infection was approximately 1 week. CONCLUSION: The incidence of nosocomial enterococcal infections in children may be controlled by limiting the number of antimicrobial agents administered to hospitalized high risk patients. The importance of our findings is relevant in an era of increasing rates of antimicrobial resistance in nosocomial enterococcal infections.

Mars scientific investigations as a precursor for human exploration.

In the past two years, NASA has begun to develop and implement plans for investigations on robotic Mars missions which are focused toward returning data critical for planning human missions to Mars. The Mars Surveyor Program 2001 Orbiter and Lander missions will mark the first time that experiments dedicated to preparation for human exploration will be carried out. Investigations on these missions and future missions range from characterization of the physical and chemical environment of Mars, to predicting the response of biology to the Mars environment. Planning for such missions must take into account existing data from previous Mars missions which were not necessarily focused on human exploration preparation. At the same time, plans for near term missions by the international community must be considered to avoid duplication of effort. This paper reviews data requirements for human exploration and applicability of existing data. It will also describe current plans for investigations and place them within the context of related international activities.

Effect of several interventions on the frequency of handwashing among elementary public school children.

BACKGROUND: The purpose of this educational project was to assess the effect of several interventions on the frequency of handwashing among elementary public school children. METHODS: Participants in this project were first-graders and fourth-graders from jurisdictions within a mid-Atlantic metropolitan area. Phase I included a baseline assessment of bathroom cleanliness as well as adequacy of supplies for handwashing in each school. During phase 2, the frequency of handwashing before lunch or after bathroom use was monitored and recorded during a 2-month period. The schools were separated into four groups: a peer education group, a hand wipes and instructional poster group, a combination of the education and hand wipes/poster groups, and a (control) comparison school. RESULTS: Overall, a significant increase occurred in the proportion of handwashing frequency from preintervention to postintervention for each intervention group (wipes: 0.50 vs 0.66, p = 0.03; education only: 0.64 vs 0.72, p = 0.02; and education and wipes: 0.45 vs 0.67, p = 0.03) but not in the control group (0.42 vs 0.46, p = 0.26). When the first 3 weeks and the last 3 weeks after intervention were compared, handwashing frequency remained unchanged in the wipes only group (0.66 vs 0.66, p = 0.96), decreased in the education group (0.77 vs 0.65, p = 0.006), and increased in the education and wipes group (0.58 vs 0.75, p = 0.003), as well as in the control group (0.37 vs 0.52, p = 0.01). CONCLUSION: Education combined with accessible convenient hand hygiene may result in a sustainable increase in the frequency of handwashing among elementary school children.

Survey of current hospital preceptorship programs in the greater Philadelphia area.

A survey of acute care hospitals in the five-county Philadelphia area was conducted to gather data on the number of preceptorship programs, the reason for their initiation and continuance, and similarities and differences in structure, process, content, and outcomes. A nonexperimental descriptive design was used. A 25-item original questionnaire consisting of both closed and open-ended questions was mailed to 60 acute care hospitals. Data analysis showed that the number of preceptorship programs had risen since 1980. The content, structure and process of these programs were similar. The majority of programs lacked a formal evaluation process or a cost analysis of program benefits.

An outbreak of Staphylococcus epidermidis septicemia.

During 45 wk from August 1980 to June 1981, the catheter sepsis rate increased from a prior 2 to 34% (23 of 68 patients on intravenous hyperalimentation). The causative organism was Staphylococcus epidermidis, grown on blood cultures in 21 of the 23 patients and on the catheter-tips of all 23. Routine cultures of the catheter-tips of the 45 patients who received intravenous hyperalimentation during this period with no evidence of catheter sepsis grew S. epidermidis on three catheter-tips (6.7%), possibly contamination during catheter removal. Sepsis resolved within 24 hr after catheter removal, with no antibiotics given for the sepsis. The organism had identical antibiograms on the blood and catheter-tip cultures in each patient, but antibiograms varied between patients. In these complex patients undergoing multiple medical events, the intravenous hyperalimentation nurse recorded that iv tubing in septic patients had leaked solution at the attachment to the catheter hub, and a review of nursing notes on charts of patients who had been on intravenous hyperalimentation revealed that a leak had been noted in the patients who subsequently had catheter sepsis. The leak was due to a manufacturing defect resulting in a decrease in diameter of the plastic connection of the iv tubing, which produced a loose attachment to the hub. The problem was remedied by switching to a Luer-lok attachment. However, in July 1982, two patients had separation of the Luer due to a manufacturing defect in the threads, followed by a catheter sepsis. Sepsis from the local contamination was not manifest until 5.4 +/- 2.7 days later. Quality control by manufacturers is emphasized.