Measuring Bachelor of Science in Nursing competencies in public/population health.

Nurses have a long history of practice in public health. More recently basic population health knowledge and skills are being required across all nursing practice settings. To prepare nurses for this practice nursing education has long included public or community health nursing (PHN) content and skills as part of prelicensure education at the baccalaureate level and above. However, little work has been done to document student competency in these areas. Competency-based education is a process whereby students are held accountable for the mastery of knowledge and skills deemed critical for an area of study. The AACN Public/Population Health Workgroup addressed the challenge of measuring baccalaureate student nursing competencies in population health by developing an unfolding case study, with embedded questions assessing selected competencies. Lacking established population health competencies in nursing curriculum at the time of this work but wanting to assess students' basic competencies across the care continuum, the Workgroup selected relevant competencies from the Council of Public Health Nursing Organizations (formerly called the Quad Council) Competencies for Public Health Nurses. Utilizing these selected competencies, the Workgroup devised the unfolding case study and piloted it with 275 baccalaureate nursing education programs across the country. The findings from the Pilot demonstrated nursing student competency achievement and how this achievement changed as students progressed through the curriculum. The authors report implications and recommendations for competency measurement in population health based on the results of the pilot.

Does contact by a family nurse practitioner decrease early school absence?

Chronic early school absence (preschool through third grade) is associated with school failure. The presence of school nurses may lead to fewer absences, and nurse practitioners in school-based health centers (SBHCs) can facilitate a healthier population resulting in improved attendance. Efforts to get students back to school are unexplored in nursing literature. This article describes a nursing intervention to decrease early school absence in two elementary schools K-3 (N = 449) and a Head Start program (N = 130). The Head Start Family Nurse Practitioner (FNP) contacted families of chronically and excessively absent students by telephone, clinic visit at school, or home visit. The aggregate percentage attendance was evaluated by grades (preschool to third grade), schools (Head Start, Elementary Schools 1 and 2), and grades and schools and compared with publicly available school district aggregate data. There were statistically significant increases in attendance from Year 1 to Year 2 at p < .05 at the elementary level but not at the Head Start level. Student demographics, types of contacts, absence reasons (including sick child), and medical diagnoses are described.

111-In-capromab pendetide imaging using hybrid-γ camera-computer tomography technology is not reliable in detecting seminal vesicle invasion in patients with prostate cancer.

OBJECTIVES: In this study, we evaluate the diagnostic utility of a hybrid γ-camera-computer tomography (SPECT-CT) indium-111 (111-In)-capromab pendetide scan in detecting seminal vesicle invasion (SVI) in select patients evaluated for primary surgical treatment of prostate cancer (CaP). METHODS AND MATERIALS: We retrospectively analyzed a prospective database of patients who underwent preoperative SPECT-CT imaging with 111-In-capromab-pendetide as part of a staging evaluation who were subsequently treated with radical surgery in our center. Only patients with clinically localized disease were included. We calculated diagnostic properties of the hybrid scan in detecting SVI compared with final pathology. Regression analyses were performed, including scan and preoperative variables to predict SVI. RESULTS: We retrieved 50 medical records matching our criteria. Median patient age was 61 years (range 45-74). Most patients had a clinical T1c CaP and biopsy Gleason score of 7 or higher. On final pathology, SVI was found in 12 (24%) specimens and radiotracer signal in the seminal vesicle region was reported in 15 (30%) imaging studies. Hybrid SPECT-CT imaging had a sensitivity of 25%, specificity of 61.9%, positive and negative predictive values of 20% and 74.3%, respectively, for detecting SVI. SPECT-CT results did not contribute significantly to SVI prediction on univariate (P = 0.627) or multivariate (P = 0.754) analyses. CONCLUSIONS: SPECT-CT imaging with 111-In-capromab-pendetide is not reliable in detecting or excluding SVI in this select cohort. High rates of positive radiotracer signals from healthy seminal vesicles raise concerns regarding pharmacologic properties of this radiotracer molecule.

Public survey and survival data do not support recommendations to discontinue prostate-specific antigen screening in men at age 75.

OBJECTIVES: To evaluate the US Preventative Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75. METHODS: Public survey: A cohort of 340 patients was surveyed at our PSA screening clinic and stratified by awareness of the recommendation and education level. Age (< 75, >or= 75), race, health insurance status, knowledge of prostate cancer, and opinion on screening discontinuation at age 75 was evaluated between groups. Disease risk and survival analysis: A cohort of 4196 men who underwent radical prostatectomy between 1988 and 2008 was stratified into age groups: < 65, 65-74, and >or= 75. Associations between clinicopathologic variables, disease risk, and survival were compared between age groups using univariate and multivariate analysis. RESULTS: Approximately 78% of men surveyed disagreed with the USPSTF recommendation. The number of men who disagreed was not significantly different between awareness groups (P = .962). Awareness of new screening guidelines showed a significant difference (P = .006) between education groups. Age >or= 75 years was predictive of high-risk disease based on D'Amico's criteria (odds ratio = 2.72, P = .003). Kaplan-Meier and Cox regression analyses showed an association of men aged >or= 75 years with higher rate of PSA recurrence, distant metastasis, and disease specific death compared with the age groups of < 65 and 65-74 (P <.05). CONCLUSIONS: Men presenting to our PSA screening clinic disagreed with discontinuation of screening at age 75. Men aged >or= 75 years had higher risk disease and poorer survival. The USPSTF recommendation was supported neither by public opinion nor disease risk and survival results.

Utilization of (111)In-Capromab pendetide SPECT-CT for detecting seminal vesicle invasion with recurrent prostate cancer after primary in situ therapy.

The aim of this study was to evaluate the diagnostic value of a hybrid (111)In-capromab pendetide fused computed tomography (CT) scan in detecting seminal vesicle invasion (SVI) in the setting of recurrent prostate cancer following primary in situ therapy. The study population comprised 59 patients, who biochemically failed primary in situ treatment based on American Society for Therapeutic Radiology and Oncology criteria. The patients underwent an (111)In-capromab pendetide/CT scan at the time of biochemical failure with a prostate (12-core) and seminal vesicle (SV) (8-core) biopsy. The diagnostic properties of the scan and magnetic resonance imaging (MRI) in detecting SVI compared to an SV biopsy were calculated. In total, eight (14%) patients had a positive SV biopsy after primary in situ prostate cancer treatment. Nine (15%) patients had positive uptake of the scan in the SV. When comparing the SV scan results to the SV biopsy, the sensitivity, specificity, positive predictive value, and negative predictive value were 37.5%, 88.2%, 33.3%, and 90.0% (95% confidence interval: 0.44-0.81), respectively. In contrast, the ability of MRI to detect SVI was 50.0%, 81.3%, 40.0%, and 86.7% (95% confidence interval: 0.46-0.85), respectively. Although the sensitivity and positive predictive value of the (111)In-capromab pendetide/CT scan are low, its specificity and negative predictive value are high. Based on these findings, the ability of the (111)In-capromab pendetide/CT scan to detect SVI seems to be comparable with MRI.

Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy.

BACKGROUND: To counsel patients adequately, it is important to understand the variables influencing satisfaction and regret following prostatectomy. OBJECTIVE: To identify independent predictors for satisfaction and regret after radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS: Patients who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy (RALP) between 2000 and 2007 were mailed cross-sectional surveys composed of sociodemographic information, the Expanded Prostate Cancer Index Composite (EPIC), and questions regarding satisfaction and regret. MEASUREMENTS: Sociodemographic variables, perioperative complications, type of procedure, length of follow-up, and EPIC scores were evaluated as independent predictors of satisfaction and regret in multivariate logistic regression analysis. RESULTS AND LIMITATIONS: A total of 400 patients responded (response rate 61%) of whom 84% were satisfied and 19% regretted their treatment choice. In multivariate analysis, lower income (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.03-0.23), shorter follow-up (OR, 0.63; 95% CI, 0.41-0.98), having undergone RRP versus RALP (OR, 4.45; 95% CI, 1.90-10.4)], urinary domain scores (OR, 2.70; 95% CI, 1.60-4.54), and hormonal domain scores (OR, 2.01; 95% CI, 1.30-3.12) were independently associated with satisfaction (p< or =0.039). In terms of regret, RALP versus RRP (OR, 3.02; 95% CI, 1.50-6.07), lower urinary domain scores (OR, 0.58; 95% CI, 0.37-0.91) and hormonal domain scores (OR, 0.67; 95% CI, 0.45-0.98), and years since surgery (OR, 1.63; 95% CI, 1.13-2.36) were again predictive (p< or =0.041). African American race (OR, 3.58; 95% CI, 1.52-8.43) and lower bowel domain scores (OR, 0.73; 95% CI, 0.55-0.97) were also independently associated with regret (p< or =0.028). CONCLUSIONS: Sociodemographic variables and quality of life were important variables associated with satisfaction and regret. Patients who underwent RALP were more likely to be regretful and dissatisfied, possibly because of higher expectation of an "innovative" procedure. We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counseling to minimize regret and maximize satisfaction.

Body mass index, prostate-specific antigen, and digital rectal examination findings among participants in a prostate cancer screening clinic.

OBJECTIVES: Prior studies suggested obese men have lower prostate-specific antigen (PSA) values. However, the association between body mass index (BMI) and digital rectal examination (DRE) findings and the association between weight at age 18 and adult PSA or DRE findings have not been examined. We sought to study the associations among BMI and weight at age 18 and adult PSA and DRE findings. METHODS: We analyzed data from 535 participants in a free prostate cancer-screening program in North Carolina held in September 2006. The associations among BMI and weight at age 18 and abnormal DRE and PSA levels were determined using multivariate logistic and linear regression models, respectively. RESULTS: A total of 391 men (73%) were overweight or obese, of whom 144 (27%) were obese. Mean +/- standard deviation and median age were 61.4 +/- 10.5 and 61 years, respectively; and 294 men (55%) were black, 219 (41%) white, and 22 (4%) neither black nor white. On multivariate analysis, higher BMI was significantly associated with lower PSA values (P = 0.03) but was not significantly associated with DRE findings. Weight at age 18 was not significantly related to adult PSA levels or DRE findings. CONCLUSIONS: In a multiethnic cohort of participants in a prostate cancer-screening clinic, obesity was associated with decreased PSA levels. We found no significant associations among BMI and DRE findings or weight at age 18 and adult PSA levels or DRE findings. The current data suggest that the PSA cut-points used to recommend biopsy need to be adjusted for the degree of obesity.