Mechanical versus Bioprosthetic Aortic Valve Replacement in Patients Aged 50 to 70 Years.

Background: This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used. Methods: We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons. Results: A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation- related bleeding (sHR, 0.35; 95% CI, 0.23-0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p<0.001). Conclusion: Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.

Surgical Management of Coronary Artery Fistulas in Children.

Background: This study investigated the surgical outcomes associated with coronary artery fistulas (CAFs) in children. Methods: We retrospectively reviewed the medical records of 23 pediatric patients who underwent surgical closure of CAFs between 1995 and 2021. At presentation, 7 patients (30.4%) exhibited symptoms. Associated cardiac anomalies were present in 8 patients. Fourteen fistulas originated from the right coronary artery and 9 from the left. The most common drainage site was the right ventricle, followed by the right atrium and the left ventricle. The median follow-up duration was 9.3 years (range, 0.1-25.6 years). Results: The median age and body weight at repair were 3.1 years (range, 0-13.4 years) and 14.4 kg (range, 3.1-42.2 kg), respectively. Cardiopulmonary bypass was used in 17 cases (73.9%), while cardioplegic arrest was employed in 14 (60.9%). Epicardial CAF ligation was utilized in 10 patients (43.5%), the transcoronary approach in 9 (39.1%), the endocardial approach in 2 (8.7%), and other methods in 2 patients (8.7%). The application of cardioplegic arrest during repair did not significantly impact the duration of postoperative intensive care unit stay or overall hospital stay. One in-hospital death and 1 late death were recorded. The overall survival rate was 95.7% at 10 years and 83.7% at 15 years. A residual fistula was detected in 1 patient. During the follow-up period, no surviving patient experienced cardiovascular symptoms or coronary events. Conclusion: Surgical repair of CAF can be performed safely with or without cardioplegic arrest, and it is associated with a favorable prognosis in children.

New Graduate Nurses' Competencies, Organizational Socialization, and Turnover Intention.

OBJECTIVE: This study aimed to identify core competencies in new-graduate nurses (NGNs) by determining which competencies affected their organizational socialization (OS) and turnover intention (TI) in their 1st year of employment. BACKGROUND: NGNs face stressful transitions with expanded nursing responsibilities that motivate them to leave their jobs. Therefore, NGN turnover in the 1st year of practice is higher than the overall nurse turnover rate. Previous research suggested that NGNs' competency levels affect their OS and TI. However, little research has been done to determine which competencies affect these variables. METHODS: Multiple linear regression analysis was performed on cross-sectional survey data to determine the effects of NGN work competencies on OS and TI. RESULTS: Health promotion, supervision, interpersonal communication, and direct care competencies significantly predicted NGNs' OS, and computer technology competency significantly predicted NGNs' TI. CONCLUSIONS: NGNs should be given early opportunities for expanded hands-on clinical experiences along with clear awareness of the organization's goals and values. Moreover, they should be offered roles that take advantage of their computer technology skills and that challenge them to contribute to their organization and nursing care in new ways.

Challenges of interprofessional geriatric practice in home care settings: an integrative review.

This integrative review identified challenges for interprofessional home care and provided recommendations for improving geriatric home care. A search of six databases identified 982 articles; 11 of them met the review's eligibility criteria and were included in the review. Quality appraisal of the included studies was performed using two tools (Critical Appraisal Skills Program for Qualitative Research and Mixed Methods Appraisal Tool), and their overall methodological quality was found to be satisfactory. After applying D'Amour et al.'s framework, four "challenge" themes emerged: (1) lack of sharing, (2) lack of partnership, (3) limited resources and interdependency, and (4) power issues. Recommendations included providing practical multidisciplinary training guided by a standardized model, establishing streamlined communication protocols and a communication platform reflecting the actual needs of users by involving them in its design, and asking interprofessional team members to commit to home care planning and to cultivate a collaborative culture and organizational support.

Kirkpatrick Model Evaluation of Accelerated Second-Degree Nursing Programs: A Scoping Review.

BACKGROUND: This scoping review examined the outcomes of accelerated second-degree baccalaureate and master of nursing programs using the Kirkpatrick four-level model. METHOD: A systematic search of four major scientific databases identified 15 articles meeting study inclusion criteria. The articles were assessed for educational outcomes, and extracted data were organized according to the four-level Kirkpatrick model consisting of reaction, learning, behavior, and results. RESULTS: Both second-degree baccalaureate and master of nursing program students showed strong academic achievement, high employment rates, and high program satisfaction but reported lack of perceived preparedness for a clinical position. No studies evaluated the long-term impacts of the programs on graduates' clinical practice or patient outcomes. CONCLUSION: Accelerated second-degree nursing programs quickly and efficiently produce licensed nurses. The care provided by the graduates of these accelerated programs needs to be investigated in both short- and long-term to better determine overall program effectiveness. [J Nurs Educ. 2021;60(5):265-271.].

New graduate nurses' self-assessed competencies: An integrative review.

Much of the ongoing shortage of nurses can be attributed to high turnover rates, and open positions are mostly filled by new graduate nurses who often lack the competencies required to provide quality patient care. An additional problem is that over 20% of these nurses leave their positions within 1 year, and low nursing competency is a main contributor to their decision. New graduate nurses' competencies are typically evaluated by experienced nurses who attempt to provide objective assessment of deficiencies, but this approach has not reduced turnover rates. Therefore, this integrative review explored new graduate nurses' self-assessed competencies. The review revealed that new graduate nurses' self-assessed deficiencies included advanced technical skills, critical thinking, communication, teamwork, helping role, and professionalism, most of which were associated with "soft" skills. New graduate nurses' possession not only of "hard" nursing skills within the cognitive and psychomotor domains but also of soft skills that mostly lie within the affective domain is vital to achieve higher retention rates. Because soft-skill competencies are problematic to objectively evaluate, recommendations include development and frequent application of a more objective measure such as a rubric, greater emphasis on soft skills in education, and supervised hands-on training in supportive practice settings.