ABSTRACT
ABSTRACT: The health impacts of climate change are pervasive and complex. The role of nurse practitioners is a key in addressing these emerging health challenges. However, few health care providers are aware of the extensive signs and symptoms that accompany climate-related health sequelae. This article explores the increasing prevalence of occupational heat stress and best practices for nurse practitioners in addressing this problem. The A CLIMATE mnemonic is a clinical tool applied to occupational heat stress and aims to address a comprehensive health assessment and proactive management. Two clinical case studies will be offered as exemplars of occupational heat stress. The cases are framed within the A CLIMATE mnemonic for health assessment and physical examination for nurse practitioner practice.
ABSTRACT
PURPOSE: Our purpose was to review needle aspiration of breast abscesses and identify factors associated with treatment by aspiration alone versus aspiration with surgical incision and drainage (I/D). METHODS: This Institutional Review Board-approved, retrospective review of the breast ultrasound database from 2008 to 2010 identified 40 patients (41 abscesses) who underwent aspiration, with or without I/D. Demographics, imaging, number of aspirations, and microbiology were reviewed. RESULTS: Twenty-two abscesses underwent aspiration only, 16 > 3 cm, 6 ≤ 3 cm (mean 4.3 cm, range 0.9-10 cm). Known risk factors included lactational (11), 3 weeks post partum (1), pregnancy (1), recent biopsy/lumpectomy (5). Nineteen abscesses underwent aspiration and I/D, 15 > 3 cm, 4 ≤ 3 cm (mean 4.1 cm, range 2.2-7.5 cm). Known risk factors included lactational (4), recurrent subareolar abscess (4), diabetes (3), hydradenitis suppuritiva (1), nipple piercing (2), smoking (1), pregnancy (1), HIV (1), and lumpectomy (1). Identified reasons for I/D included lack of improvement/recurrence (12), fistula (3), and one electively after clinical improvement of a recurrent subareolar abscess. CONCLUSIONS: Abscesses associated with pregnancy and lactation or breast biopsy are effectively managed with aspiration, even when large. Recurrence, chronicity, or fistula may require surgical intervention.
Subject(s)
Abscess/diagnostic imaging , Abscess/therapy , Academic Medical Centers , Breast Diseases/diagnostic imaging , Breast Diseases/therapy , Abscess/complications , Adolescent , Adult , Biopsy, Needle/methods , Body Piercing , Breast Diseases/complications , Breast Feeding , Diabetes Mellitus , Drainage/methods , Female , HIV Infections/complications , Humans , Middle Aged , Postpartum Period , Pregnancy , Retrospective Studies , Risk Factors , Severity of Illness Index , Smoking , Suction , Ultrasonography, Mammary/methods , Young AdultABSTRACT
A social network analysis of eighty-nine midlevel health care professionals showed that middle managers' strategic knowledge is positively associated with championing alternative ideas and synthesizing new information for upper management. In addition, the relationship between knowledge and middle management strategic activities in informal networks is moderated by the manager's social position.
Subject(s)
Decision Making, Organizational , Hospital Administrators , Hospitals, Religious/organization & administration , Institutional Management Teams , Professional Role , Social Support , Catholicism , Economic Competition , Humans , Interprofessional Relations , Knowledge , Leadership , Operations Research , Organizational Case Studies , Organizational Culture , Organizational InnovationABSTRACT
This study adopts a social network methodology to explore the achievement of strategic consensus in a hospital system. On the basis of responses from 88 middle managers, the authors determined that a manager's (1) knowledge of the internal capabilities and the external environment of an organization and (2) his or her social position in a management structure significantly affect the realization of strategic consensus. Managerial knowledge is essential, and its importance in the consensus-building process is enhanced by a manager's social position.
