The critical difference assignment: an innovative instructional method.

Nurse educators are faced with the challenge of developing and evaluating learning methods that promote knowledge acquisition, problem solving, and the development of clinical judgment to meet today's expectations of new graduates. Clinical judgment is at the heart of decision making and drives nursing action. It encompasses perceptions and intellectual processing of information through mental operations of reasoning, resulting in appropriate actions.

The war against bacteria: how were sulphonamide drugs used by Britain during World War II?

Penicillin is often considered one of the greatest discoveries of 20th century medicine. However, the revolution in therapeutics brought about by sulphonamides also had a profound effect on British medicine, particularly during World War II (WWII). Sulphonamides were used to successfully treat many infections which later yielded to penicillin and so their role deserves wider acknowledgement.

The component separation technique for hernia repair: a comparison of open and endoscopic techniques.

The open components separation technique (CST) for hernia repair allows for autologous tissue repair with approximation of the midline fascia in patients with complex hernias. CST requires creation of large undermining skin flaps, whereas the endoscopic component separation technique (ECST) is performed without division of the epigastric perforating vessels and may minimize wound morbidity. A review of patient demographics and outcome measures of patients undergoing CST and ECST between November 2008 and February 2010 was performed.

Association of blood transfusion and venous thromboembolism after colorectal cancer resection.

Introduction: Red blood cell (RBC) transfusion is a common event in the perioperative course of patients undergoing surgery. Transfused blood can disrupt the balance of coagulation factors and modulates the inflammatory cascade. Since inflammation and coagulation are tightly coupled, we postulated that RBC transfusion may be associated with the development of venous thromboembolic phenomena.

Liver transplantation for the treatment of liver metastases from neuroendocrine tumors: an analysis of the UNOS database.

Objective: To determine outcomes in patients undergoing liver transplantation (LT) for metastatic neuroendocrine tumors (NETs).

Design: Retrospective analysis.

Setting: University of Kentucky Medical Center.

Endoluminal versus open repair of descending thoracic aortic rupture: a review of the National Trauma Databank.

Objectives: Open repair for blunt thoracic aortic injury is associated with significant mortality. Interest in less invasive methods of repair has developed and results of several clinical studies have shown successful emergency repair with endovascular stent grafting. The purpose of this report was to compare endoluminal versus open repair of traumatic thoracic aortic injury in the National Trauma Databank.

The endoscopic component separation technique for hernia repair results in reduced morbidity compared to the open component separation technique.

Purpose: The component separation technique for hernia repair results in significant wound morbidity due to the need for large undermining skin flaps. The endoscopic component separation technique allows for advancement of the abdominal wall while preserving the blood supply originating from the epigastric vessels. This study compares the outcomes following hernia repair utilizing these techniques.

Incidence and risk factors for 30-day postdischarge mortality in patients with vascular disease undergoing major lower extremity amputation.

Background: Our goal was to analyze the incidence and risk factors for 30-day postdischarge mortality in patients with vascular disease undergoing major lower extremity amputation.

Methods: We queried the American College of Surgeons National Surgery Quality Improvement Program data set from the years 2005 to 2009 for amputations with vascular disease diagnosis codes. We analyzed in-hospital mortality and postdischarge mortality by year of the study and relative to length of hospital stay.

Intraoperative transfusion of small amounts of blood heralds worse postoperative outcome in patients having noncardiac thoracic operations.

Background: Massive intraoperative transfusion is associated with increased morbidity and mortality in patients undergoing noncardiac thoracic operations. We examined whether this association carries over to patients who receive only 1 to 2 units of packed red blood cells (PRBCs) during their operation.

Methods: We queried the American College of Surgeon's National Surgical Quality Improvement Project database for patients undergoing noncardiac, nonvascular thoracic operations during a 5-year period.

Early outcomes and risk factors in venous thrombectomy: an analysis of the American College of Surgeons NSQIP dataset.

Objectives: Thrombus removal has been shown to improve venous physiology in acute iliofemoral deep-venous thrombosis. Our study focuses on the contemporary application of venous thrombectomy based on data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

Methods: Data submitted by over 200 hospitals to the ACS NSQIP participant use file was accessed for the years 2005-2008.

Second prize: In-vivo physiological impact of alpha blockade on the porcine ureter with distal ureteral obstruction.

Purpose: Alpha blockade has been well described clinically for expulsion of distal ureteral stone. However, the in-vivo effects of α-blockade on ureteral dynamics during stone passage are not clear. We studied the effects of oral alfuzosin on ureteral pressure and peristalsis in a distally obstructed porcine ureter.

Orbital floor fractures: outcomes of reconstruction.

Since the 1950s, myriad materials have been used to reconstruct orbital floor fractures. Technological advances have afforded new materials for reconstruction. Recent comparisons of materials have not been reported.

Temporal relationship between positive margin rate after laparoscopic radical prostatectomy and surgical training.

Objectives: To evaluate the potential impact of the experience of the first assistant on the positive surgical margin rate (PSMR) after laparoscopic radical prostatectomy (LRP). The impact of training surgical residents and fellows on patient outcomes is difficult to quantify.

Methods: A single-institution prospective database of 303 patients who underwent LRP between 2003 and 2008 was evaluated.

A middle fidelity model is effective in teaching and retaining skill set needed to perform a laparoscopic pyloromyotomy.

Introduction: An inanimate technical skills trainer for laparoscopic pyloromyotomy (LP) has not been described. A middle fidelity model, reproducing the three consistent steps in LP, was developed as a component of a teaching module for surgical residents, and tested on medical students, residents, and pediatric surgeons.

Materials And Methods: In the first phase of the study, a cohort of 29 pediatric surgeons used the LP model and completed questionnaires about the model's realism and accuracy.

Integrated approaches to improve birth outcomes: perinatal periods of risk, infant mortality review, and the Los Angeles Mommy and Baby Project.

This article provides an example of how Perinatal Periods of Risk (PPOR) can provide a framework and offer analytic methods that move communities to productive action to address infant mortality. Between 1999 and 2002, the infant mortality rate in the Antelope Valley region of Los Angeles County increased from 5.0 to 10.

Stromal cell-derived factor-1 and hepatocyte growth factor guide axon projections to the extraocular muscles.

Vertebrate eye movements depend on the co-ordinated function of six extraocular muscles that are innervated by the oculomotor, trochlear, and abducens nerves. Here, we show that the diffusible factors, stromal cell-derived factor-1 (SDF-1) and hepatocyte growth factor (HGF), guide the development of these axon projections. SDF-1 is expressed in the mesenchyme around the oculomotor nerve exit point, and oculomotor axons fail to exit the neuroepithelium in mice mutant for the SDF-1 receptor CXCR4.

Saving costs, saving health care providers' backs, and creating a safe patient environment.

Back injuries are increasing among health care providers and are related to a multitude of factors, including repetitive tasks related to patient handling, the aging of the nursing workforce, higher patient acuity levels, and an increased prevalence of obesity in patients, as well as limited workspaces in patient rooms. An estimated 12% of nurses leave the profession annually because of back injuries, and more than 52% complain of chronic back pain and injuries. Implemented in response to rising costs of health care providers' injuries, a safe patient handling program resulted in decreased injuries from staff performing work-related duties, and decreased workers' compensation claims, which resulted in significant cost savings and improved patient satisfaction.

Using a point-of-dispensing clinic for prophylaxis of meningococcal disease.

A point-of-dispensing clinic was held to distribute ciprofloxacin prophylaxis when 2 high school students were reported to the health department with invasive meningococcal disease. Of more than 3,100 school staff and students in attendance, 2,861 received prophylaxis. A survey was administered to students 2 weeks postclinic to better understand the motivations for clinic attendance and to quantify side effects of oral 500-mg ciprofloxacin prophylaxis.

General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay.

Background: Studies of specific procedures have shown increases in infectious complications with operative duration. We hypothesized that operative duration is independently associated with increased risk-adjusted infectious complication (IC) rates in a broad range of general surgical procedures.

Study Design: We queried the American College of Surgeons National Surgical Quality Improvement Program database for general surgical operations performed from 2005 to 2007.

Variations in early outcomes of endovascular aneurysm repair with alternate endograft configurations.

Background: Most endovascular abdomincal aortic aneurysm (AAA) repairs (EVARs) performed in the United States utilize a bifurcated configuration. The purpose of this study was to examine the effect of alternate graft configurations on early outcomes during EVAR.

Methods: Patients in the National Surgical Quality Improvement Program (NSQIP) participant use file who underwent elective EVAR for AAA from 2005 to 2007 were stratified by configuration using CPT codes.

Blood transfusion is associated with increased morbidity and mortality after lower extremity revascularization.

Background: Little is known about the significance of blood transfusion in patients with peripheral arterial disease. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to examine the effect of intraoperative blood transfusion on the morbidity and mortality in patients who underwent lower extremity revascularization.

Methods: We analyzed data from the participant use data file containing vascular surgical cases submitted to the ACS NSQIP in 2005, 2006, and 2007 by 173 hospitals.

Thirty-day NSQIP database outcomes of open versus endoluminal repair of ruptured abdominal aortic aneurysms.

Background: The mortality of ruptured abdominal aortic aneurysm (rAAA) has decreased 3.5% per decade in the last 50 years to a current rate of 40%-50%. Reports have indicated that endovascular repair (EVAR) is feasible for rAAA and may offer potential benefits over open repair.