Improving referrals to a fracture liaison service: Screening for osteoporosis.

With the elderly population living longer and 'baby boomer's now reaching the age of 65, there is great concern regarding a lack of diagnosis and treatment of osteoporosis. Osteoporosis is a well-known problem, yet there continue to be gaps regarding screening and treatment. An orthopaedic practice in the Southeastern United States specializing in bone health has an internal Fracture Liaison Service (FLS) that was not being fully utilized by the providers. A quality improvement project was implemented following the recommended FLS guidelines to identify individuals that should receive referral to the FLS. Chart audits were completed to analyze both pre- and post-implementation phases. An alert button was introduced into the electronic health record to prompt orthopaedic surgeons to refer to the FLS clinic when individuals met the requirements of age and a first-time fragility fracture. Descriptive data showed 5% FLS referrals in 2019. After implementation of the alert button the FLS referrals for 2020 were 19%, providing a 14% overall improvement rate. Evidence supports using standardized screening processes and that referring to an FLS is best practice for improving the treatment of osteoporosis and for decreasing morbidity, mortality, and health care cost.

Academic Support Programs Utilized for Nursing Students at Risk of Academic Failure: A Review of the Literature.

AIM: The purpose of the literature review is to evaluate and discuss the various types of academic support programs used for at-risk nursing students to identify those that are most effective. BACKGROUND: Nurse educators are concerned about students admitted to nursing programs who are unable to successfully complete the program. METHOD: To determine the format and efficacy of academic support programs, the literature review addressed the identification of at-risk students and academic support programs applicable to all student groups. RESULTS: Nurse educators need to develop and implement plans to support and retain students in order to address the impending nursing shortage. CONCLUSION: Replacing a student lost to academic failure is difficult. Although utilized in different manners, academic support programs are an effective retention strategy.

Caring for the Veteran, military and family member nursing competencies: Strategies for integrating content into nursing school curricula.

In the United States, one in every 15 persons is a Veteran (U. S. Department of Veterans Affairs, 2016; U. S. News & World Report, 2017). An estimated 27% of these Veterans receive healthcare through the Veteran's Health Administration (VHA), leaving 73% to seek care in civilian hospitals (Bagalman, 2014). Realistically, most nurses in the United States will care for military members, Veterans or family members in a variety of healthcare systems and settings. Nurse educators are positioned to lead efforts in providing nursing students with the knowledge necessary to provide competent care and serve as advocates for our nation's heroes. Recent military deployments and news about the VHA have increased awareness of this population. This article describes competency development resulting from an academic-practice partnership experience between two baccalaureate programs and a national military medical center. Project SERVE, Students' Education Related to the Veteran Experience, utilizes a didactic-experiential model consisting of activities designed to teach students core concepts, including understanding military culture, poly-trauma, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and issues facing families and care-givers. This article includes competencies, delineating the Knowledge, Skills, Attitudes, and resources for the provision of care to the Veteran population. The authors offer strategies to integrate care of Veterans, and military/family members content into nursing programs and replicate similar experiences. Opportunities for future development, challenges, faculty resources for curricular inclusion, and student reflections of the experience are presented.

Repair of a vesicocutaneous fistula using negative-pressure wound therapy and urinary diversion via a nephrostomy tube.

BACKGROUND: This article describes an unusual case of a vesicocutaneous fistula in a patient with a history of radiation therapy and recent abdominal surgery. CASE: A 61-year-old woman was transferred to our acute care facility from a rehabilitation facility, with poor nutritional intake and a concern for urine draining from her wound. A nephrostomy tube was placed (she had only 1 functioning kidney) and negative-pressure wound therapy was used to close the fistula. CONCLUSION: Urinary diversion via a nephrostomy tube and negative-pressure wound therapy were used to successfully and safely close this vesicocutaneous fistula.

The hazards of honey: infantile botulism.

Infantile botulism is a rare cause of neuromuscular weakness resulting from ingestion of Clostridium botulinum-an anaerobic Gram-positive bacillus found universally in soil. The only definite food source known to cause infantile botulism is honey; previously, links to formula milk have been postulated but not definitely sourced. We present an interesting case report of a 2-month-old infant with this rare condition, including the diagnostic difficulties that ensued. A brief overview of the condition follows. This is the first case in the UK in which C botulinum was successfully isolated from both the patient and the suspected source-a jar of honey. The importance of food labelling as a public health message is highlighted.

What future health care providers will need to know about child abuse and neglect.

Child abuse and neglect have reached epidemic proportions. State and federal laws mandate that allied health professionals report suspected child abuse and neglect. Academic and continuing education programs could assist allied health professionals to be legally responsible, mandated reporters of child abuse and neglect. This study examined the training needs of allied health students to be legally responsible in reporting child abuse and neglect. A questionnaire was administered to 236 students enrolled in 5 allied health programs. The questionnaire addressed the knowledge base and perceptions of allied health students in regard to child abuse and neglect. Results revealed that most allied health students felt inadequately prepared academically in the topic of child abuse and neglect. Only half of the students knew they could be charged with a crime for failure to report suspicions of child abuse and neglect. Nursing students, female students, and students older than 25 years were those likely to report child abuse and neglect. Students appear to have insufficient preparation in the areas of knowing how to report child abuse and neglect as well as their responsibilities to do so as allied health professionals.

The role of high frequency oscillatory ventilation in the management of children with severe traumatic brain injury and concomitant lung pathology.

OBJECTIVE: To report the use of high frequency oscillatory ventilation (HFOV) in two children with severe traumatic brain injury and concurrent lung pathology where conventional mechanical ventilation was ineffective. DESIGN: : Case report. SETTING: Regional intensive care unit in a pediatric teaching hospital. PATIENTS: Two severely head-injured children (both with postresuscitation Glasgow Coma Scores of 3), one of whom was age 11 yrs and developed an invasive fungal (rhizomucor) pneumonia, while the other age 5 yrs had bilateral lung contusions. Both were treated according to local head injury guidelines, which included conventional ventilation. Despite increasing conventional ventilatory support, CO2 removal became problematic in both cases, making the intracranial pressure control and consequent maintenance of adequate cerebral perfusion pressure difficult. In both patients, a dramatic reduction in intracranial pressure and improvement in cerebral perfusion pressure was observed soon after the use of HFOV. Additionally, inotropic support was weaned by 50% in both children after commencing HFOV. A significant increase in the mean arterial blood pressure occurred in one child with HFOV. INTERVENTION: Use of HFOV as an alternative to conventional mechanical ventilation. CONCLUSION: HFOV may have utility in the management of selected cases of severe brain trauma with concurrent lung pathology where conventional ventilation is ineffective.

Does requiring continuing education units for professional licensing renewal assure quality patient care?

Although most states in the United States require health care professionals to complete continuing education units (CEUs) for licensure renewal, little evidence to date has established a relationship between completing CEUs and clinical competency. Considering the high cost of health care delivery and services, it would be prudent for both managers and consumers of health care to review the costs and benefits of requiring CEUs for professional licensing renewal. This study features an extensive review of the literature to analyze the supportive as well as the opposing views of mandatory CEUs for professional license renewal. Most of the studies reviewed reported almost no relationship between participation in traditional continuing education courses and improved patient outcomes. Several recommendations evolved out of this study for improving patient outcomes following the attendance of continuing education courses.