Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care.

Background: Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus.

Aims And Objectives: Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland.

Nursing's Wicked Problems: Partnering With Academic Leadership to Develop Solutions.

Nursing is in a challenging place, and we are facing many incredibly complex issues that are steeped in culture and tradition. These "wicked problems" often arise when organizations face constant change or unprecedented challenges. In this article, we discuss current issues that hinder all nurse leaders from elevating nursing as a profession, with a particular focus on the role and contributions of the academic nurse leader in creating and sustaining positive change.

Support Methods for Healthcare Professionals Who Are Second Victims: An Integrative Review.

A second victim is a healthcare provider who has been involved in a critical event. A critical event is a clinical situation in which an unforeseen clinical outcome occurs, or the clinical deterioration of the patient takes place for many different reasons. The patient and his/her family are the first victims.

The nurse+engineer as the prototype V-shaped professional.

Background: Descriptions of convergence research include promises to solve complex societal problems, such as environmental determinants of health and social determinants of health, through the integration of diverse disciplines, such as nursing and engineering, to create novel frameworks, such as the V-shaped professional.

Purpose: The purpose of this paper was to define the nurse+engineer as a prototypical V-shaped professional.

Methods: Starting from a description of the I-shaped discipline of nursing and the I-shaped discipline of engineering, we follow an intentional pathway to define the concept of the nurse+engineer as a new V-shaped professional.

Cost burden and net monetary benefit loss of neonatal hypoglycaemia.

Background: Neonatal hypoglycaemia is a common but treatable metabolic disorder that affects newborn infants and which, if not identified and treated adequately, may result in neurological sequelae that persist for the lifetime of the patient. The long-term financial and quality-of-life burden of neonatal hypoglycaemia has not been previously examined.

Methods: We assessed the postnatal hospital and long-term costs associated with neonatal hypoglycaemia over 80 year and 18 year time horizons, using a health-system perspective and assessing impact on quality of life using quality-adjusted life year (QALYs).

Author Correction: Determination of RNA structural diversity and its role in HIV-1 RNA splicing.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Comparison of risk-of-bias assessment approaches for selection of studies reporting prevalence for economic analyses.

Objectives: Within cost-effectiveness models, prevalence figures can inform transition probabilities. The methodological quality of studies can inform the choice of prevalence figures but no single obvious candidate tool exists for assessing quality of the observational epidemiological studies for selecting prevalence estimates. We aimed to compare different tools to assess the risk of bias of studies reporting prevalence, and develop and compare possible numerical scoring systems using these tools to set a threshold for inclusion of reports of prevalence in an economic analysis of neonatal hypoglycaemia.

An examination of nurse-authored patents: Implications for nursing practice.

Background: Recognition for medical inventions and innovations is largely associated with physician-researchers, scientists, and engineers. The term "nurse" is largely absent from patents awarded in the United States. Yet, as front-line healthcare providers, who better to add to the current population of inventors and innovators of new, meaningful scientific and engineering medical discoveries than specialized advanced practice nurses and their registered nurse colleagues? Although medical inventions and innovations are not entirely new activities for nurses, the authors speculate that greater opportunities exist for these healthcare professionals to lead in and be officially recognized for medical care discoveries and advancements by having their names on patents awarded.

Disability-Related Questions for Administrative Datasets.

High rates of unemployment among people with disability are long-standing and persistent problems worldwide. For public policy, estimates of prevalence and population profiles are required for designing support schemes such as Australia's National Disability Insurance Scheme; for monitoring implementation of the United Nations Convention on Rights of Persons with Disabilities; and for monitoring service access, participation, and equity for people with disability in mainstream systems including employment. In the public sector, creating a succinct identifier for disability in administrative systems is a key challenge for public policy design and monitoring.

Cost-Utility Analysis of Prophylactic Dextrose Gel vs Standard Care for Neonatal Hypoglycemia in At-Risk Infants.

Objective: To evaluate the long-term costs and impact on quality of life of using prophylactic dextrose gel in patients at increased risk of developing neonatal hypoglycemia.

Study Design: A cost-utility analysis was performed from the perspective of the health system, using a decision tree to model the long-term clinical outcomes of neonatal hypoglycemia, including cerebral palsy, epilepsy, vision disturbances, and learning disabilities, in patients at increased risk of neonatal hypoglycemia who received prophylactic dextrose gel vs standard care. Model parameters including likelihoods of hypoglycemia and admission to a neonatal intensive care unit, were based on the pre-Hypoglycemia Prevention with Oral Dextrose Study.

Determination of RNA structural diversity and its role in HIV-1 RNA splicing.

Human immunodeficiency virus 1 (HIV-1) is a retrovirus with a ten-kilobase single-stranded RNA genome. HIV-1 must express all of its gene products from a single primary transcript, which undergoes alternative splicing to produce diverse protein products that include structural proteins and regulatory factors. Despite the critical role of alternative splicing, the mechanisms that drive the choice of splice site are poorly understood.

The outcome of fundoplication in patients with GERD based on abnormal impedance testing.

Introduction: The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance test.

Methods: Records of patients who had an abnormal off-medication impedance test (≥ 48 total reflux events) who underwent antireflux surgery were reviewed and divided into two groups: normal [pH-] or abnormal [pH+] esophageal acid exposure (DeMeester score > 14.

Biological Insights into Chemotherapy Resistance in Ovarian Cancer.

The majority of patients with high-grade serous ovarian cancer (HGSOC) initially respond to chemotherapy; however, most will develop chemotherapy resistance. Gene signatures may change with the development of chemotherapy resistance in this population, which is important as it may lead to tailored therapies. The objective of this study was to compare tumor gene expression profiles in patients before and after treatment with neoadjuvant chemotherapy (NACT).

Can Impedance-pH Testing on Medications Reliably Identify Patients with GERD as Defined by Pathologic Esophageal Acid Exposure off Medications?

Introduction: Impedance-pH testing (MII-pH) while patients are on acid suppression medications is frequently used to evaluate persistent reflux symptoms. The aim of this study was to determine whether MII-pH on medications can reliably identify patients with gastroesophageal reflux disease (GERD) as defined by pathologic esophageal acid exposure off medications, and to determine if there is a threshold of total reflux episodes on medications where pH testing off medications may be unnecessary.

Methods: A retrospective review identified all patients between 1/2010 and 4/2017 who underwent MII-pH testing on PPI medications and subsequently had pH testing off medications.

Enablers and challenges to advanced nursing and midwifery practice roles.

Aim: To describe the enablers and challenges to the development and implementation of advanced nursing and midwifery practice roles in Ireland.

Background: Leadership strategies need to be put in place to enhance the development and implementation of advanced nursing and midwifery practice roles.

Method: A descriptive qualitative approach using semi-structured interviews with key stakeholders (n = 15) was undertaken with nurses and midwives working in specialist and advanced practice roles and participants from other areas such as legislative, regulatory, policy, pharmacy, medicine and education.

The Nurse-Engineer: A New Role to Improve Nurse Technology Interface and Patient Care Device Innovations.

Purpose: The purpose of this article is to describe two innovative biomedical engineering and nursing collaborations designed to educate a new cadre of professionals and develop new knowledge and innovations (robots, patient care devices, and computer simulation).

Organizing Construct: Complex health problems demand a highly skilled response that uses teams of professionals from various disciplines. When the biomedical engineering lens is expanded to include the practical perspective of nursing, opportunities emerge for greater technology-nurse interface and subsequent innovation.

Cost Analysis of Cot-Side Screening Methods for Neonatal Hypoglycaemia.

Background: Babies at risk of neonatal hypoglycaemia are often screened using cot-side glucometers, but non-enzymatic glucometers are inaccurate, potentially resulting in over-treatment and under-treatment, and low values require laboratory confirmation. More accurate enzymatic glucometers are available but at apparently higher costs.

Objective: Our objective was to compare the cost of screening for neonatal hypoglycaemia using point-of-care enzymatic and non-enzymatic glucometers.

Cost Analysis of Treating Neonatal Hypoglycemia with Dextrose Gel.

Objective: To evaluate the costs of using dextrose gel as a primary treatment for neonatal hypoglycemia in the first 48 hours after birth compared with standard care.

Study Design: We used a decision tree to model overall costs, including those specific to hypoglycemia monitoring and treatment and those related to the infant's length of stay in the postnatal ward or neonatal intensive care unit, comparing the use of dextrose gel for treatment of neonatal hypoglycemia with placebo, using data from the Sugar Babies randomized trial. Sensitivity analyses assessed the impact of dextrose gel cost, neonatal intensive care cost, cesarean delivery rate, and costs of glucose monitoring.

Aggressive Angiomyxoma of the Vulva and Bladder.

Background: Aggressive angiomyxoma is a rare, locally infiltrative tumor, frequently occurring in female patients. Although wide local excision is considered standard therapy, radical surgery may be needed.

Case: A 49-year-old woman presented with an aggressive angiomyxoma involving the vulva and bladder.

The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

Aims And Objectives: To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice.

Background: There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system.

An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review.

Objectives: This paper presents the results of a systematic rapid review and narrative synthesis of the literature of the outcomes and impact of specialist and advanced nursing and midwifery practice regarding quality of care, cost and access to services.

Design: A rapid review was undertaken of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses' and midwives' specialist and advanced practice roles.

Data Sources: A search of the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE) was undertaken from 2012 to 2015.

Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service: A Randomized Controlled Trial.

Objective: To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service.

Methods: We conducted a prospective, randomized, controlled trial comparing an enhanced recovery after surgery protocol with routine postoperative care among women undergoing laparotomy on the gynecologic oncology service. Protocol elements included: preoperative counseling, regional anesthesia, intraoperative fluid restriction, and early postoperative ambulation and feeding.

Free vascularized lymph node transfer for treatment of lymphedema: A systematic evidence based review.

Background: Free vascularized lymph node transfer (VLNT) is a relatively novel technique for treatment of lymphedema. The purpose of this systematic review was to evaluate the current evidence on VLNT and to determine if there is objective data concerning improved outcomes.

Methods: A literature search of PubMed, EMBASE and CENTRAL electronic databases was conducted to identify articles written in the English language on VLNT for treatment of lymphedema.