The "nursing cheat sheet," a guide to aid nursing in management of patient care.

The aim of this study was to promote nursing and practitioner satisfaction by improving communication and reducing rapid response team (RRT) activations and code blues hospitalwide by implementing the nursing cheat sheet, a list of key steps to be done before calling the primary provider. This prospective observational study took place over a year at a 636-bed teaching hospital in Central Texas. Education regarding the nursing cheat sheet was provided to nurses at monthly meetings, unit huddles, and interdisciplinary rounds. Units received monthly follow-up education and reminders, and the nursing cheat sheet was posted at nursing work areas. RRT activations and code blues were counted daily. After implementing the nursing cheat sheet, RRT activations were lower than the pre-intervention average and were outside the control band for July, August, and November. The number of code blues did not deviate from the control bands. The authors did not see a reduction in code blues after implementation of the nursing cheat sheet, but the average number of RRT activations decreased, indicating a significant difference in the number of RRT activations. It is not clear that this decrease was due to the intervention.

A case of adult granulosa cell tumor of the testis.

BACKGROUND: Adult granulosa cell tumors of the testis (AGCTT) are classified as sex cord-stromal tumors. Only 31 cases have been reported. Typical presentation includes a slowly enlarging, painless testicular mass. Associated findings are gynecomastia, decreased libido, and erectile dysfunction. Immunohistochemistry can be used to confirm the diagnosis. CASE REPORT: A 22-year-old male presented with complaint of mild pain in both testicles. A testicular ultrasound revealed a 4.0×3.8×4.6 mm hypoechoic lesion within the left testicle. Serum tumor markers (STM) included lactate dehydrogenase (LDH) measuring 146 IU/L (98-192), serum alpha-1-fetoprotein (AFP), 2.89 ng/mL (0-9), and plasma beta human chorionic gonadotropin (Beta HCG) measuring less than 0.50 mIU/mL (<0.50-2.67). Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast was normal. A radical orchiectomy was recommended but the patient refused. He agreed to surveillance with imaging and serum tumor markers (STM). The patient's testicular ultrasound showed the mass to be stable in size and STMs remained negative. The patient agreed to an orchiectomy 9 months after his diagnosis. This case is the first reported with c-kit-positive immunohistochemistry. His post-operative course has been unremarkable. CONCLUSIONS: AGCTT is a rare tumor and information regarding its presentation, gross and microscopic morphology, and immunohistochemical characteristics is lacking. This report provides an update of the immunohistochemical findings and adds to the available data concerning this tumor. Based on the results of this case, future reports that include c-kit immunohistochemistry would be beneficial to evaluate its utility in diagnosing AGCTT.