S.O.S. (STUDENTS' OPTIMAL SUCCESS): A MODEL FOR INSTITUTIONAL ACTION TO SUPPORT MINORITY NURSING STUDENTS.

BACKGROUND: Success of minority students in higher education is an issue of great relevance today, as the changing United States demographic necessitates that programs in higher education afford success across cultural groups. PURPOSE: The purpose of this study was to examine thematic concepts of academic success as perceived by current nursing students in 2 entry-level nursing programs, and to propose a theoretical model to maximize the success of minority students. METHOD: Data were collected from 31 students enrolled in two registered nursing (RN) programs (baccalaureate and associate) at separate urban academic institutions in the Midwestern region of the United States. Two opened-ended questions were asked from the students. Question 1 asked, "What has helped you be most successful in pursuing your nursing degree at your school?" Question 2 asked, "What could be done to help make your college education more meaningful and/or less stressful?" RESULTS: Key factors of institutional commitment, communication of expectations, academic, social and financial support,feedback and involvement were identified as factors to students' optimal success. CONCLUSION: This data resulted in development of a theoretical model that can serve a framework for the success of minority nursing students.

MINORITY UNDERGRADUATE NURSING STUDENT SUCCESS.

BACKGROUND: Minority providers are more likely to practice in underserved areas with minority populations. Currently the representation of minorities in healthcare professions is less than that of the United States population. More research is needed to examine specific variables associated with educational success of minority students. PURPOSE: The purpose of this study is to examine, and increase the understanding of, current factors that influence success among ethnic and minority nursing students. METHODS: The revised Minority Student Nurse Questionnaire (MSNQ) was utilized for this study with a sample of 31 students from 2 entry-level nursing programs in the Midwest. RESULTS: Minority students were slightly older than traditional college students and consisted of African-American Black, Native (American) Indian, Asian, Hispanic/Latino, and Hawaiian. Students reported multiple factors that influenced their higher education experience. Academic services and cultural organizations were available, free, but were used by less than half of the students. Several sources of financial assistance are important, including scholarships, federal subsidized and unsubsidized loans, and grants. Students most strongly disagreed with the statement that 'the number of minorities in this program is representative of the number of minorities overall.' Students felt that several services were supportive and helpful strategies for success. CONCLUSION: Although progress has been made to improve success of minority students, numbers continue to lag between demographic population overall.

Pain, opioids, and confusion after arthroplasty in older adults.

BACKGROUND: Postoperative confusion is a common complication in older adults, particularly after total joint replacement (arthroplasty). Confusion after surgery can result in slower mobility progression, longer hospital stay, and increased patient distress. Postoperative pain has been shown to be a risk factor related to confusion; however, there is limited evidence regarding pain level, medication use, and confusion development in postoperative arthroplasty patients. PURPOSE: To evaluate development of postoperative confusion and the current practice of pain management for older adult patients with hip or knee arthroplasty. METHODS: Two-month retrospective chart review of medical records at a large, Midwestern, private hospital. Pain assessments were performed on a regular basis using self-report 11-point Numeric Rating Scale (0-10). Opioid use was scored using an equianalgesic conversion chart. RESULTS: Ninety-eight patients met inclusion criteria and 97 received treatment with opioids during the first 48 hours postoperatively. No patients received opioid agents that are contraindicated in older adults. Thirty-three patients had evidence in the medical record of confusion during the first 48 hours postoperatively. Lower equianalgesic dose was significant for increased age and increased confusion on postoperative day 1 (POD 1) and POD 2. Patients with higher equianalgesic scores were less likely to meet benchmark pain scores less than 5 on POD 0, POD 1, and POD 2. CONCLUSIONS: Patients receiving lower amounts of opioids in the first 48 hours after surgery were more likely to be confused on POD 1(p = .023) and POD 2 (p = .049).

Amiodarone-induced pulmonary toxicity: case study with syndrome analysis.

Amiodarone is often prescribed for the control of atrial and ventricular arrhythmias. While generally effective, the potential for a variety of side effects is substantial. Pulmonary toxicity, leading to acute or chronic respiratory failure, manifests with cough, dyspnea, infiltrates on chest radiograph, and a potential for progression to death. Although routinely cited as an adverse effect of amiodarone, it is relatively rare in terms of statistical incidence. In an effort to shed light on this syndrome, we present a stereotypical case study in amiodarone-induced pulmonary toxicity, as a prelude to a review of theorized pathophysiology, epidemiology, clinical presentation, diagnosis, therapeutics, monitoring recommendations, and areas for future research.

Impact of missing data on analysis of postoperative cognitive decline (POCD).

BACKGROUND: There are a variety of techniques to handle missing data, such as removing observations with missing data from the analyses or estimating the missing values using various imputation algorithms. Dropping subjects from standard regression models and analyzing only completers, however, may bias results from the true value of reality. Likewise, 'last-observation-carried-forward' may not be an appropriate technique for studies measuring a particular variable over time. METHODS: This dataset was part of a larger prospective cohort study that examined postoperative cognitive decline (POCD) after surgery in older adults. Data collectors had provided the reasons for data being missing using adjectives including 'confused', 'incapable', 'stuporous', 'comatose', and 'intubated'. Data having these qualitative notations were re-coded as 'incapable' and trial scores of zero were recorded. This value of '0' indicated that the patient was cognitively incapable of performing the neuropsychological test. RESULTS: Missing data varied by cognitive test and postoperative day. Re-coding word list scores from missing to zero when a patient was too cognitively impaired to complete the tests improved sample size by 13.5% of postoperative day (POD) 1 and 12.8% on POD 2. Recoding missing data to zero for the digit symbol test resulted in 29.3% larger sample size on POD 1 and 22.7% on POD 2. Verbal fluency gained 15.7% sample size with re-coding for POD 1 and 13.7% for POD 2. Re-coding of each cognitive test reduced missing data sample size to 20-32% in all cognitive tests for each day. DISCUSSION: Our data suggest that using a scoring system that enters a value of '0' when patients are unable to perform cognitive testing did significantly increase the number of patients that met the diagnosis of postoperative cognitive decline using the criteria that were determined a priori and may lessen chances of type II error (failure to detect a difference).

Twelve-month fall outcomes among delirium subtypes.

PURPOSE: The purpose of this study was to examine falls as an outcome measure at 12 months for two-group comparison (delirium cases and noncases) and five-group comparison (noncases, hypoactive, hyperactive, mixed delirium cases, and subsyndromal delirium cases). DESIGN: Three hundred and twenty patients enrolled in the Delirium in Rural Long-Term Care Facilities Study, which examined subjects for delirium during a 28-day surveillance period, were followed longitudinally for fall events for 12 months. Fall events were recorded and data analyzed using date of "first fall" as the referent for statistical analysis. METHODS: Fall reports were completed for all subjects for 12 months following delirium surveillance. Fall records were reviewed and the number of days until the first fall event was calculated. Data were censored for deaths that occurred during the 12-month period. FINDINGS: Five group analysis of variance (noncases, hyperactive delirium, hypoactive delirium, mixed delirium, and subsyndromal delirium) showed significant differences in Functional Independence Measure scores (p = .001) and number of medications (p = .001). The percentage of patients who fell was higher in all delirium subtypes than in noncases at 12 months and was statistically significant for subsyndromal subjects. Two patients, one each from the subsyndromal and mixed delirium subtypes, died from injuries sustained during falls. CONCLUSIONS: Delirium appears to increase the risk for falls. CLINICAL RELEVANCE: Increased surveillance and fall prevention strategies are needed for patients who experience transient cognitive changes such as delirium and subsyndromal delirium, even after delirium resolution.

Twelve-month mortality among delirium subtypes.

This study used data from the Delirium Among the Elderly in Rural Long-Term Care Facilities Study and data from the National Death Index (NDI) to examine mortality among 320 individuals. Individuals were grouped into noncases, subsyndromal cases, hypoactive delirium, hyperactive delirium, and mixed delirium on the basis of scoring using the Confusion Assessment Method (CAM), NEECHAM Scale, Mini-Mental State Examination (MMSE), Clinical Assessment of Confusion-A (CAC-A), and Vigilance A instruments. Risk ratios of mortality using "days of survival" did not reach statistical significance (α = .05) for any subgroup. Underlying cause of death (UCD) using International Classification of Disease, 10th version (ICD-10), showed typical UCD among older adults. There appeared to be clinical differences in UCD between delirium subgroups. Findings supported the conclusion that careful monitoring of patients with delirium and subsyndromal delirium is needed to avoid complications and injuries that could increase mortality.

Factors associated with recovery from early postoperative delirium.

Delirium occurs in 14% to 56% of postoperative, hospitalized elderly persons, making it one of the most common postoperative complications for the older patient. The aim of this study was to determine factors associated with recovery of delirium from postoperative day one (POD 1) to postoperative day two (POD 2). The hypothesis was that those with less pain are more likely to recover from delirium by POD 2. Patients aged 65 or older who were scheduled for noncardiac surgery, spoke English, and developed delirium on POD 1 as detected by the Confusion Assessment Method (CAM) were included (n = 176). Postoperative delirium on POD 2 was also measured with the CAM. Postoperative pain was assessed on PODs 1 and 2 using the Numeric Rating Scale (NRS). One hundred seventy-six patients developed delirium on POD 1, with 66 (38%) recovering from delirium by POD 2. The mean age of those patients who recovered from delirium was 72.5 ± 5.7 (n = 66), whereas the mean age of those patients who did not recover from delirium was 75.9 ± 6.5 (n = 110). Multivariate logistic regression revealed that patients less than age 75 were more likely to recover from delirium (OR = 2.31; 95% CI = 1.18-4.53; P = .015), as were patients who had pain scores of less than 5 on POD 2 (OR = 2.59; 95% CI = 1.26-5.35; P = .0098). Patients with lower pain levels (NRS ≤4) were also more likely to recover from delirium on POD 2. The type of postoperative pain therapy (the use or nonuse of patient-controlled analgesia) was not related to delirium recovery. The results suggest that aggressive pain management in the first 48 hours postoperatively may be important in promoting recovery from postoperative delirium.