NYS Nonprofit Hospital Assessment and Response to Environmental Pollution as Community Health Need: Prevalence in Community Benefit Practices.

CONTEXT: Given the impact of environmental pollution on health and health inequity, there may be substantial value in integrating assessment and response to pollution into nonprofit hospital community benefit processes. Such hospital engagement has not yet been studied. OBJECTIVES: We take a preliminary step of inquiry in investigating if nonprofit hospitals in New York State (NYS) assess, identify, or respond to environmental pollution as part of community benefit processes. DESIGN: This study is of retrospective, observational design. Data were abstracted from community health needs reports (2015-2017), associated implementation plans, and related IRS (Internal Revenue Service) filings from a randomly geographically stratified selection of NYS nonprofit hospitals. PARTICIPANTS: The sample includes 53 hospitals from 23 counties. The sampling frame consists of NYS nonspecialty private nonprofit hospitals. MAIN OUTCOME MEASURES: Dichotomous findings for the following: (1) engagement of environmental pollution in the process of assessment of community health needs; (2) environmental pollution concern identified as a priority community health need; (3) strategic planning present to address pollution identified as community health need; and (4) action taken on same. RESULTS: We found that 60.5% (95% confidence interval [CI], 0.46-0.74) of hospitals evidenced some form of assessment of environmental pollution and 18.9% (95% CI, 0.09-0.32) identified pollution as a priority community health need. However, no hospital went on to take independent or collaborative planning or action to address pollution. In additional analysis, we found that social justice in hospital mission was a positive predictor of assessment of environmental pollution. CONCLUSIONS: For NYS hospitals, we found a substantial presence of assessment and identification of pollution as a community health concern. Our finding of the absence of response to environmental pollution represents a gap in community benefit implementation. This indicates a yet untaken opportunity to address racial and economic environmental health injustices and to improve population health.

A Multi-Centre, Single-Arm Clinical Study to Confirm Safety and Performance of PuraStat®, for the Management of Bleeding in Elective Carotid Artery Surgery.

Anastomotic bleeding in vascular surgery can be difficult to control. Patients, in particular those undergoing carotid surgery, have often been started on treatment with dual antiplatelet agents and receive systemic heparinization intraoperatively. The use of local hemostatic agents as an adjunct to conventional methods is widely reported. 3-D Matrix's absorbable hemostatic material RADA16 (PuraStat®), is a fully synthetic resorbable hemostatic agent. The aim of this study is to confirm the safety and performance of this agent when used to control intraoperative anastomotic bleeding during carotid endarterectomy (CEA). A prospective, single-arm, multicenter study involving 65 patients, undergoing CEA, in whom the hemostatic agent was applied to the suture line after removal of arterial clamps. Patients were followed up at 24 h, discharge, and one month after surgery. Time to hemostasis was measured as the primary endpoint. Secondary endpoints included hemostasis efficacy and safety outcomes, blood loss, intraoperative and postoperative administration of blood products, and incidence of reoperation for bleeding. A total of 65 cases (51 male and 14 female) undergoing CEA, utilizing patch reconstruction (90. 8%), eversion technique (6.1%), and direct closure (3.1%) were analyzed. All patients received dual antiplatelet therapy preoperatively and were administered systemic intravenous heparin intraoperatively, as per local protocol. The mean time to hemostasis was 83 s ± 105 s (95% CI: 55-110 s). Primary hemostatic efficacy was 90.8%. The mean volume of product used was 1.7 mL ± 1.1 mL. Hemostasis was achieved with a single application of the product in 49 patients (75.3%). Two patients required a transfusion of blood products intraoperatively. There were no blood product transfusions during the postoperative period. The intraoperative mean blood loss was 127 mL ± 111.4 mL and postoperatively, the total mean drainage volume was 49.0 mL ± 51.2 mL. The mean duration of surgery was 119 ± 35 min, and the mean clamp time was 35 min 12 s ± 19 min 59 s. In 90.8% of patients, there was no presence of hematoma at 24 h postoperatively. Three returned to theatre due to bleeding (2 in the first 24 h), however, none of these cases were considered product related. Overall, there were no device-related serious adverse events (SAE) or unanticipated device-related SAEs reported. Use of the hemostatic agent PuraStat® is associated with a high rate of hemostatic efficacy (90.8%) and a short time to hemostasis. The safety of the product for use on vascular anastomoses has been demonstrated.

The Nurse-Engineer: A New Role to Improve Nurse Technology Interface and Patient Care Device Innovations.

PURPOSE: The purpose of this article is to describe two innovative biomedical engineering and nursing collaborations designed to educate a new cadre of professionals and develop new knowledge and innovations (robots, patient care devices, and computer simulation). ORGANIZING CONSTRUCT: Complex health problems demand a highly skilled response that uses teams of professionals from various disciplines. When the biomedical engineering lens is expanded to include the practical perspective of nursing, opportunities emerge for greater technology-nurse interface and subsequent innovation. A joint nursing-engineering degree program provides the ideal preparation for a well-informed nurse-engineer who can explore new and innovative solutions that will improve care and patient outcomes. APPROACH: A review of the literature provides the background on innovation and engineering in nursing and a rationale for the development of two innovative joint degrees, as well as a description of those programs. FINDINGS: These innovative programs will advance healthcare-related technology and maximize the potential contribution of the nursing profession in the design and implementation of creative solutions. They also have the potential to increase the skills and knowledge for students enrolled in biomedical engineering or Bachelor of Science in nursing programs individually, providing them with interdisciplinary training and exposure. CLINICAL RELEVANCE: Important patient care improvement opportunities are missed when nurses are not actively engaged in patient care device innovation and creation. Innovative nurse and engineer collaborations are needed in various forms to leverage nurse ingenuity and create patient care innovations.

The Case of the Neighbour's Cat Causing a Symptomatic (Mycotic) Aortic Aneurysm and an Infected Endograft.

INTRODUCTION: Aortic endograft infection is a rare but serious complication following endovascular aneurysm repair. An unusual presentation associated with an uncommon organism is reported. CASE REPORT: A 69 year old female was prescribed but failed to complete a full course of co-amoxiclav following a forearm cat bite. Nine days later she was admitted with pyrexia, left flank pain, and haematuria. Empiric treatment for a urinary tract infection was started. Pasteurella multocida was isolated from blood culture performed during this attendance. Imaging demonstrated hydronephrosis and a 5.5 cm aortic aneurysm with features of impending leak. Emergency endovascular repair was performed without immediate complication. Four weeks following stent graft insertion, the patient was readmitted with loss of consciousness. Imaging demonstrated an infected graft with an associated psoas abscess. The endograft was explanted and reconstruction performed with the femoral vein. Only at this point was the history of a cat bite and positive blood cultures elicited and recognised as relevant. CONCLUSION: Detailed history taking can expose unusual sources of infection. Ideally, an infected aortic endograft should be explanted and the septic focus eradicated prior to autogenous aortic reconstruction.

The Diabetes Disparity and Puerto Rican Identified Individuals.

Purpose The purpose of this systematic review was to describe what is known about the diabetes disparity affecting Puerto Rican identified adults living in the continental United States as well as illuminate areas that merit further investigation. Methods The CINAHL and PubMed databases were searched using the keywords Hispanic, Puerto Rican, and type 2 diabetes. Search limits included < 10-year-old, peer-reviewed, systematic reviews, available in the English language. The abstracts of 124 articles were reviewed, and 7 articles were reviewed in depth. Results The Puerto Rican identified Hispanic subgroup is disproportionately affected by diabetes-the diabetes disparity. Puerto Rican identified Hispanic adults are less affected by citizenship status, may be less affected by English proficiency, use health care services differently, and have contextually different fatalistic views of diabetes compared with other Hispanic identified people. Spiritual/religious influences, associated mental health problems, and general cultural practices related to diabetes self-care are understudied in this group. Conclusion Ambiguous use of the term Hispanic should be avoided when describing Hispanic subgroups. Stronger, more robust studies are needed to understand the unique cultural forces influencing the poor diabetes outcomes and individual behaviors that contribute to generally suboptimal diabetes self-care for Puerto Rican adults with type 2 diabetes.

The experience of a new deanship for two Robert Wood Johnson Foundation executive nurse fellows.

With the graying of the professoriate, many deans in nursing are moving toward retirement, which provides an opportunity for emerging leaders to move into deanships. New deans move through predictable stages and enjoy a honeymoon, allowing for some mistakes that might not be tolerated later. Early wins are essential in addition to planned changes so as not to overwhelm faculty with change. It is critical to learn the new culture, identify leaders, perform a thorough assessment as the basis for a strategic plan, and be honest and transparent. The ability to mobilize a cohesive, functioning team is critical to success.

Electronic health record: implementation across the Michigan Academic Consortium.

The Michigan Academic Consortium of academic nurse-managed primary care centers supported member sites to venture into computer-based advances with the potential to improve quality of health services and students' educational experiences. The experiences of this consortium as it incorporated electronic health records in tandem with an electronic patient management system at several of its member sites reveal the benefits and challenges of such an endeavor. The processes of selection, adoption, and implementation of the electronic health record are discussed in this article. Many lessons learned in the process are discussed.

Grading scales used in the management of aneurysmal subarachnoid hemorrhage: a critical review.

The use of grading scales to predict clinical outcomes following aneurysmal subarachnoid hemorrhage (aSAH) is commonplace. In recent times management of aSAH patients has developed such that surgical intervention is taking place earlier in the course of the illness. Given the complex and multifactoral clinical picture of these patients, there is an increased impetus to examine and reevaluate the relative merits and predictive characteristics of grading scales. The measurement characteristics and predictive power of the following instruments were reviewed: Fisher Scale (FS), Glasgow Coma Scale (GCS), Glasgow Outcome Score (GOS), Hunt and Hess (HH) Scale, Karnovsky Performance Scale (KPS), and the World Federation of Neurological Surgeons (WFNS) Scale. No uniformly conclusive findings were found when the HH Scale, GCS, and WFNS Scale were used to predict clinical outcomes. No instrument consistently outperformed any other across age or severity. Contradictory findings were reported. Difficulties were encountered in comparing instruments because of administration, scoring schemes, timing of assessments, and psychometric properties, such as interrater reliability. Reports on newly developed instruments often lacked the replication data necessary to effectively compare measures currently in use. The timing of measurements and the use of serial measures emerged as important factors in the prediction of clinical outcomes. Assessments taken close to the time of surgical intervention were found to have superior predictive abilities.

Orem and the nursing process: New directions for the 1990s.

Orem considers that the activities or operations of the nursing process involve both technical and professional aspects of nursing. The term technologic-professional operations is now used as a general description of all the activities a nurse must present when performing nursing duties. These technologic-professional operations form the basis of the nursing process and include the following steps: diagnostic, prescriptive, treatment/regulatory and case management.