ABSTRACT
A review and discussion of creating nurse residency programs employing the recommendations from accrediting bodies to demonstrate organizational value. Utilizing an accredited framework to create nurse residency programs demonstrates organizational impact and value by ensuring evidence-based structures and plans are incorporated to accomplish patient safety and other organizational goals, meet healthy workplace goals, decrease turnover and improve nursing job satisfaction. Analysis includes a description of the Institute of Medicine report, nurse recruitment and retention, and associated costs; and the American Nurses Credentialing Center (ANCC) Practice Transition Program guides to developing the residency program. An example curricula and exploration of improvement indicators supports the conclusion that a successful transition to practice for nurses prepares them with both confidence and competence to deliver quality patient care.
ABSTRACT
In a study exploring the impact of a new physician practice model on staff's perceptions of their work environment, no statistically significant differences were found; however, some interesting results were obtained. Nurses should strive to improve working relationships not only with nurses and physicians, but also with members of the entire health care team and system.
Subject(s)
Communication , Hospital Units/organization & administration , Models, Organizational , Patient Care Team/organization & administration , Cross-Sectional Studies , Delivery of Health Care/organization & administration , Hospitalists/organization & administration , Humans , Nurse's Role , Physician-Nurse Relations , WorkplaceABSTRACT
PURPOSE: The inadequacies of prostate specific antigen testing have created a need for novel markers for prostate cancer screening. The investigational ProCaM™ prostate cancer methylation assay detects aberrant methylation of DNA in cells associated with prostate cancer. We describe a large, prospective, multicenter study done to verify the performance of this assay. MATERIALS AND METHODS: The assay is designed to detect epigenetic modifications in the 3 markers GSTP1, RARß2 and APC, which are indicative of prostate cancer. A total of 232 men with cancer and 283 without cancer from 18 clinical sites were evaluated by trained operators at central testing laboratories. Study inclusion criteria were age 40 to 75 years, total prostate specific antigen between 2.0 and 10.0 ng/ml, and a digital rectal examination result. All participants signed an informed consent form and underwent transrectal ultrasound guided needle biopsy with 10 or more cores. RESULTS: Assay sensitivity was 60%, specificity was 80% and the informative rate was 97%. Assay predictive accuracy was higher than that of age, digital rectal examination, family history, prostate specific antigen, prior negative biopsy and prostate volume (AUC 0.73 vs 0.52 to 0.66, p <0.038). Risk factors plus the assay improved overall predictive power (AUC 0.79, p = 0.001). A man with a positive prostate cancer methylation result was 7.7 times more likely to have high grade cancer. CONCLUSIONS: The prostate cancer methylation assay correlated with positive biopsy and with Gleason score. This assay has the potential to add value to the biopsy decision making process by improving current prostate cancer screening algorithms to more accurately identify men with prostate cancer.
Subject(s)
Biological Assay/methods , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/genetics , Adenomatous Polyposis Coli/genetics , Adult , Aged , Algorithms , CpG Islands/genetics , DNA Methylation , Epigenesis, Genetic , Glutathione S-Transferase pi/genetics , Humans , Male , Middle Aged , Neoplasm Grading , Prospective Studies , Prostate-Specific Antigen/blood , Receptors, Retinoic Acid/genetics , Risk Factors , Sensitivity and SpecificityABSTRACT
PURPOSE: Prostate specific antigen tests have low specificity, which frequently results in unnecessary biopsy and typically limits screening to patients with prostate specific antigen greater than 4.0 ng/ml. We evaluated an investigational prostate cancer methylation specific polymerase chain reaction assay that detects aberrant methylation in 3 markers (GSTP1, RARbeta2 and APC) that indicate the presence of prostate cancer. MATERIALS AND METHODS: The assay was evaluated in 337 post-digital rectal examination urine samples (178 cancer and 159 noncancer) collected prospectively at a total of 9 clinical sites. Samples were processed wholly or after division into equal portions. Subject prostate specific antigen was 2.0 to 10.0 ng/ml. All subjects underwent transrectal ultrasound guided needle biopsy with 6 or greater cores sampled. Detection of 1 or greater markers indicated positivity. RESULTS: Methylation specific polymerase chain reaction assay performance was better in whole than in divided urine cohorts (p = 0.035). Assay AUC was 0.72 in the whole urine cohort and 0.67 in the combined population. These values were higher than those of prostate specific antigen alone using 4.0 ng/ml as the cutoff (p = 0.00 and 0.01, respectively). Moreover, the assay together with the Prostate Cancer Prevention Trial risk calculator or a standard nomogram significantly improved AUC in the whole urine cohort and the combined population vs predictive algorithms alone (p <0.05). Assay positive predictive value was 54% in whole urine cohort with prostate specific antigen 2.0 to 4.0 ng/ml and negative predictive value was 87% with prostate specific antigen 4.1 to 10.0 ng/ml. Assay positive predictive value was higher in subjects with all 3 methylation markers positive. CONCLUSIONS: These data demonstrate that this investigational assay used in conjunction with current screening algorithms may potentially add value to the biopsy decision making process.
