The academic-practice gap: Strategies for an enduring problem.

The academic-practice gap in nursing is well documented. Academe is criticized for producing nurses insufficiently prepared to fully participate in patient care. Practice settings are criticized for having unrealistic expectations of new graduates. This article is based on a review of the literature and an exploration of contemporary practices used to bridge academic and practice partnerships. Differences in outcome expectations for new graduates between academe and practice are outlined and consequences of the gap for new graduates, patients, and employers are discussed. Five specific strategies to address the gap are discussed, with the primary realm and responsibility for two falling to education, one to practice, and two to both. Strategies discussed include increased use of simulated learning in nursing education; disruptive innovations in education that promote learner-centered active learning; extended orientation/Transition to Practice Programs for new graduates; dedicated education units; and academic service partnerships. Current literature suggests the viewpoints of academic and practice leaders continue to appear divergent. Closing the gap will require a dedicated and coordinated response from both academe and clinical practice.

Ocular pulse amplitude as a diagnostic adjunct in giant cell arteritis.

BACKGROUND: To develop an algorithm based on the ocular pulse amplitude (OPA) to predict the probability of a positive temporal artery biopsy (TAB) result in the acute phase of suspected giant cell arteritis (GCA). METHODS: Unilateral TAB was performed and ipsilateral OPA measurements were taken by Dynamic Contour Tonometry. Among the clinical signs and laboratory findings tested in univariate analyses, OPA, Erythrocyte Sedimentation Rate (ESR) and thrombocyte count showed a strong association with a positive TAB result. Algorithm parameters were categorized into three groups (OPA >3.5, 2.5-3.5, and <2.5 mm Hg; ESR <25, 25-60, and >60 mm/h; thrombocyte count <250'000, 250'000-500'000, and >500'000/µl). Score values (0, 1, and 2) were attributed to each group, resulting in a total score range from 0 to 6. A univariate logistic regression analysis using the GCA diagnosis as the dependent and the total score as the independent variate was fitted and probability estimates were calculated. RESULTS: Thirty-one patients with suspected GCA undergoing TAB during an eighteen-month observation period were enrolled. Twenty patients showed histologically proven GCA. Four patients had score values ≤2, fourteen between 3 and 4, and thirteen of ≥5. The corresponding estimated probabilities of GCA were<7, 52.6, and >95%. CONCLUSION: The present study confirms previous findings of reduced OPA levels, elevated ESR, and elevated thrombocyte counts in GCA. It indicates that a sum score based on OPA, ESR, and thrombocyte count can be helpful in predicting TAB results, especially at the upper and the lower end of the sum score range.

Treatment of traumatic corneal abrasions: a three-arm, prospective, randomized study.

PURPOSE: To compare three different treatment modalities for traumatic corneal abrasions. METHODS: We conducted a prospective, randomized, masked, three-arm clinical study of patients presenting with superficial corneal foreign bodies. Treatment modalities were: (1) pressure patching with ofloxacin ointment (patch group, PG, n = 18), (2) therapeutic contact lens with ofloxacin eye drops (contact lens group, CLG, n = 20) and (3) ofloxacin ointment alone (ointment group, OG, n = 28). Primary outcome measure was the difference of the mean corneal abrasion area between the three groups at 3 different time points (baseline, day 1 and day 7). RESULTS: A total of 66 patients were included in the study over a period of 2 years. Mean initial corneal abrasion area was 3.6 ± 3.4 mm² in the PG, 4.2 ± 4.0 mm² in the CLG and 3.7 ± 3.1 mm² in the OG (p = 0.875). Differences in corneal abrasion area at any time point were not statistically significant (abrasion area decrease from presentation to day 1 was 3.4 ± 3.3 mm² in the PG, 4.1 ± 4.0 mm² in the CLG and 3.5 ± 3.1 mm² in the OG, p = 0.789). The epithelium was healed in all patients at day 7. CONCLUSIONS: Treating traumatic corneal abrasions by pressure patching, a bandage contact lens or ointment alone was equal in reducing the abrasion area or reducing pain. According to our results the treatment of choice for traumatic abrasions may be adapted to the needs and preferences of the patient.

[Hypoglobus--illusive or real? Etiologies of vertical globe displacement in a tertiary referral centre]. / Hypoglobus--Schein oder Sein? Ätiologien vertikaler Bulbusdislokationen in einem tertiären Zentrumsspital.

BACKGROUND: While exophthalmus is quantifiable with readily available measurement tools, there is no such tool for hypoglobus/hyperglobus. Despite its possible life-threatening causes only few articles address the etiologies of vertical globe displacement in the current literature. The aim of our study was to describe etiologies of hypoglobus and to analyze the ratio of malignant diseases. PATIENTS AND METHODS: 3000 portrait photographs taken in our ophthalmology department between 2005 and 2009 were retrospectively screened for patients with vertical globe displacement. Pictures were assessed by three independent ophthalmology-trained observers and matched to the diagnosis based on patient records. RESULTS: 95 patients with supposed vertical globe displacement were identified. Vertical globe displacement was due to an intracranial or orbital disease in 45 patients including 6 patients with a malignant disease. Additional 10 patients had thyroid associated orbitopathy. 11 patients turned out to have mere facial asymmetry, 26 patients had strabism and four patients had an ocular prosthesis. CONCLUSIONS: The etiologies of hypoglobus ranges from orbital fractures to life-threatening malignant tumors. Distinction between apparent and true hypoglobus can be challenging.

[Continuous intraocular pressure measurement: First results with a pressure-sensitive contact lens]. / Kontinuierliche Augeninnendruckmessung : Erste Ergebnisse einer drucksensitiven Kontaktlinse.

BACKGROUND: A prototype of a pressure-sensitive contact lens (CL-DCT) based on dynamic contour tonometry (DCT) has been developed for continuous intraocular pressure (IOP) monitoring. The purpose of the present study was to assess the clinical applicability of this CL-DCT. MATERIAL AND METHODS: In 24 healthy subjects continuous IOP recording with the CL-DCT for 100 s was accomplished including IOP monitoring during 2 consecutive Valsalva manoeuvres. The measurement procedure was repeated after 5 min on the same eye and compared with the initial measurement. RESULTS: Continuous pressure curves were recorded in 20 subjects. The CL-DCT revealed an individual increase in IOP from 0.74 to 8.26 mmHg during the Valsalva manoeuvres. Comparison of the 2 consecutive IOP measurements yielded a mean deviation of +/-0.4 mmHg. CONCLUSIONS: CL-DCT allows non-invasive and continuous measurements of IOP. The measured values are comparable to the expected ones. Further studies are necessary to compare the measurement accuracy of CL-DCT with that of slit lamp adapted DCT (SL-DCT).

Rare retinal haemorrhages in translational accidental head trauma in children.

PURPOSE: The characteristic findings in accidental head injury consist of linear skull fracture, epidural haematoma, localized subdural haematoma, or cortical contusion because of a linear or translational impact force. Retinal haemorrhages have been found, although uncommon, in accidental head trauma. METHODS: We performed a retrospective study of 24 consecutive cases of children with severe head injuries caused by falls. Inclusion criteria were skull fractures and/or intracranial haemorrhages documented by computerized tomography. All patients underwent a careful ophthalmic examination including dilated indirect fundoscopy within the first 48 h following admission. RESULTS: No retinal haemorrhages could be found in patients whose accidents were plausible and physical and imaging findings were compatible with reported histories. Excessive bilateral retinal haemorrhages were found in only three children with the typical signs of shaken baby syndrome. In eight children, trauma had led to orbital roof fractures. CONCLUSIONS: Retinal haemorrhages were not found in any of the patients with accidental trauma despite the severity of their head injuries. Hence, we add more evidence that there are strong differences between the ocular involvement in accidental translational trauma and those in victims of non-accidental trauma. Fall-related injuries carry a very low risk of retinal haemorrhages.

Fibrotic racemose haemangioma of the retina.

BACKGROUND: The racemose - or arteriovenous - haemangioma of the retina is a rare developmental anomaly. It can be associated with similar vascular anomalies in other regions of the central nervous system (Wyburn-Mason syndrome). HISTORY AND SIGNS: We report a 24-year-old woman with a chronic headache from our outpatient clinic. Other than a white tortuous strand in the retina of the right eye, which resembled a filarium at first glance, no pathologies were found. Its ends were located at the optic disc forming a sling-shaped lesion extending to the anterior nasal periphery. Partial filling was shown by fluorescence angiography. An MRI of the neurocranium detected no additional vascular abnormalities. THERAPY AND OUTCOME: So far our patient has not suffered from any visual complaints and she will be followed up yearly. CONCLUSIONS: We show an unusual presentation of a retinal racemose haemangioma. Diagnosis of this entity should prompt further examinations to exclude any additional haemangiomas with respect to the Wyburn-Mason syndrome.

Rapid progressive extramedullary plasmacytoma in the orbit.

BACKGROUND: Plasma cell tumors of the orbit are uncommon and mostly the first manifestation of a multiple myeloma (MM). Primary extramedullary plasmacytoma (EMP) of the orbit is exceedingly rare and only a few cases have been reported so far. Differentiation of an EMP from a MM is important, since 9.5 years have been reported as the mean survival of EMP, compared with a mean survival of 3 to 4 years for multiple myeloma. HISTORY AND SIGNS: A 68-year-old man presented with a history of rapid progressive extramedullary plasmacytoma in the right orbit, increasing in size within a few weeks. MR imaging revealed an intraorbital mass measuring 5.2 x 4.7 x 3 cm. The earlier performed biopsy was positive for plasmacytoma of the lambda light chain type. Systemic work-up was negative for further tumor spread. THERAPY AND OUTCOME: Irradiation (a maximum of 80 Gy) and several chemotherapy cycles showed no effect. Exenteration with sparing of the upper and lower lid skin was performed. The residual defect was covered by a Thiersch graft. Although the orbit had been irradiated with the maximal dose, the Thiersch graft healed well. CONCLUSION: Normally, EMP is slow to increase in size. In our patient, marked growth of tumor was noted within one week. One underlying reason is the poorly differentiated, blastic morphology leading to this rapid tumor growth. However, particular molecular features, like a t(4;14), could not be demonstrated.

Whose job is it anyway? Governance restructuring clarifies board roles.

System and network formation often leads to multiple layers of governance that have left boards confused about their roles and authority. Governance restructuring can create a streamlined system of leadership and clarify board responsibilities.

Effective boards: working smarter to meet the challenge.

The responsibilities that boards must shoulder these days weigh a lot more heavily than they used to. But what are trustees doing about them? Here's some advice on what you should be doing and how you can do it.