The Impact of Nurse-Led Innovations and Tactics During a Pandemic.

The COVID-19 pandemic hit southeast Michigan hard and a rapid influx of patients forced Beaumont Health to shift rapidly into an emergency management model with a laser focus on transforming clinical care and administrative processes to meet complex patient care needs. Navigating this landscape required agility, surge planning, strong interprofessional teams, transformational leadership, nurse-led innovations, support, and transparency to manage the ever-changing environment. This article explains nursing's response and nurse-led innovations that were implemented to meet the needs of the community, patients, and staff, as well as lessons learned to ensure preparedness for any potential future surge.

Epidemiology of abusive head trauma in West Virginia children <24 months: 2000-2010.

BACKGROUND: Few states have published statewide epidemiology of abusive head trauma (AHT). OBJECTIVE: To examine the statewide epidemiology of AHT in West Virginia (WV), with the primary objective of establishing AHT incidence for comparison to national data, and to use as a baseline for comparison to incidence post-implementation of a statewide AHT prevention program. PARTICIPANTS AND SETTING: AHT cases in children less than 2 years old were identified from the 3 tertiary pediatric centers in WV. METHODS: Cases were identified by using ICD-9 codes for initially identifying those with injuries which might be consistent with AHT, followed by medical record review to determine which of these met the criteria for inclusion as a case. Medical examiner data was used to find additional cases of AHT. Using the number of cases identified along with relevant census data, incidence of AHT was calculated. RESULTS: There were 120 cases of AHT treated in WV hospitals from 2000 to 2010, 100 of which were WV residents. The incidence was 36.1/100,000 children <1 year of age and was 21.9 cases per 100,000 children <2 years of age. Incidence in infants increased during the latter years (2006-2010) of the study to 51.8/100,000 compared to the incidence during 2000-2005, which was 24.0/100,000 (p < .01). CONCLUSIONS: Compared to US national, state and regional figures, the WV incidence of AHT was among the highest. In addition, the incidence of AHT increased significantly over the study period. Possible factors contributing to the rise in incidence are discussed.

Examining Patient Willingness to Pay for Magnetic Resonance Imaging Guided Prostate Biopsy: Implications in the Era of Health Savings Accounts.

INTRODUCTION: The proliferation of health savings accounts has empowered patients to participate in medical decisions through a direct financial incentive. Using conjoint analysis we examined how much extra patients with a health savings account would be willing to pay for magnetic resonance imaging-transrectal ultrasound fusion guided prostate biopsy over transrectal ultrasound guided prostate biopsy. METHODS: We enrolled men who were 55 to 70 years old from a general urology clinic. We performed a literature review, distributed surveys and conducted semi-structured interviews to develop and rank attributes commonly used to compare magnetic resonance-ultrasound to transrectal ultrasound guided prostate biopsy. Using conjoint surveys we asked participants to select their preferred choice between 2 hypothetical biopsy interventions with differing levels of the attributes and cost. Results of the conjoint surveys were analyzed using a multinomial probit model. We performed a sensitivity analysis to assess the stability of our results after adjusting for age, history of prostate cancer, race, education, marital status, income and Zip Code of residence. RESULTS: Patients were willing to pay $1,598 more for a biopsy intervention with increased sensitivity to detect all cancer from 43% to 51% and $2,034 more for a negative predictive value improvement from 70% to 90%. Patients were not willing to pay extra for an intervention with improved sensitivity to detect high risk cancer alone. These estimates did not change with our sensitivity analysis. CONCLUSIONS: Our findings suggest that patients are willing to pay approximately $1,500 to $2,000 from a health savings account for a biopsy intervention with a benefit profile similar to that of magnetic resonance-ultrasound guided prostate biopsy.

Evaluation of primary/preferred language data collection.

A literature review was conducted to identify peer-reviewed articles related to primary/preferred language and interpreter-use data collection practices in hospitals, clinics, and outpatient settings to assess its completeness and quality. In January 2011, Embase (Ovid), MEDLINE (Ovid), PubMed, and Web of Science databases were searched for eligible studies. Primary and secondary inclusion criteria were applied to selected eligible articles. This extensive literature search yielded 768 articles after duplicates were removed. After primary and secondary inclusion criteria were applied, 28 eligible articles remained for data abstraction. All 28 articles in this review reported collecting primary/preferred language data, but only 18% (5/28) collected information on interpreter use. This review revealed that there remains variability in the way that primary/preferred language and interpreter use data are collected; all studies used various methodologies for evaluating and abstracting these data. Likewise, the sources from which the data were abstracted differed.

Teenage pregnancies that end in abortion: what can they tell us about contraceptive risk-taking?

BACKGROUND and methodology In 1999, the Government set the ambitious target of halving the number of under-18 conceptions by 2010. It is now clear that this target will not be met. Much media and policy attention has been paid to teenage mothers, and yet approximately 50% of teenage conceptions end in abortion not motherhood. In London, where the present research was based, the percentage is significantly higher. The research into teenage abortion and repeat abortion, though based in London, generated insights that could potentially help different areas reduce the number of under-18 conceptions ending in abortion. A qualitative research methodology was adopted and a wide range of interviews were conducted with young women, and professionals, in 10 London primary care trusts. RESULTS Our analysis adds to a substantial body of qualitative research that points to the complexity of sexual decision-making for young women. Contraceptive risk-taking was evident as some young women spoke of the difficulties they experienced with user-dependent methods (primarily the condom and the pill) in often unplanned, sexual encounters. They were also generally poorly informed about different contraceptive methods. Misunderstandings about fertility also emerged as an important issue that can lead young women to draw the wrong conclusions if they do not become pregnant following unprotected sex. CONCLUSIONS Young people need improved access to, and informed understanding of, the full range of contraceptive methods available to them. In addition, efforts should be made to enable young women to have a better understanding of their own likely fertility.

Understanding hyperbaric oxygen therapy and its use in the treatment of compromised skin grafts and flaps.

Nonhealing wounds represent a problem involving inadequate oxygenation of the tissues that can lead to hypoxic injury. Hyperbaric oxygen therapy can be used as an adjunctive therapy for compromised grafts and flaps that have failed to show improvement with standard wound therapy and offer additional physiologic benefits in the reversal of wound hypoxia and hypoperfusion. A literature review confirms the efficacy of hyperbaric oxygen therapy in nonhealing wounds and compromised skin grafts and flaps. The purpose of this article is to review the role of oxygen and physiological effects of hyperbaric oxygen therapy in wound healing and to provide an overview of the hyperbaric oxygen therapy experience including indications, types of chambers, patient preparation, complications, and treatment protocols. This article is intended to provide nurses working in plastic surgery the information necessary to consider the benefits that hyperbaric oxygen therapy can offer to improve the healing potential of patients with compromised skin grafts and flaps.