Development and validation of a Clostridium difficile risk assessment tool.

The incidence of Clostridium difficile infection has increased rapidly during the past decade, increasing lengths of stays in the hospital, costs, and mortality rates. To address this increased incidence, we performed a retrospective case-control study using known risk factors to develop a tool to determine which patients are at risk for infection. Multivariate analysis generated a combination of risk factors associated with development of infection including prior admission, endoscopy within 30 days, cephalosporin/fluoroquinolone use, length of stay 7 days or longer, age 65 years or older, body mass index less than 25, and albumin level less than 2.

Coaching of physicians by RNs to improve diabetes care.

Purpose: The purpose of this study is to describe preliminary results of an innovative quality improvement intervention focused on improving physician practice patterns in diabetes care via Coaching Physicians by RN certified diabetes educators (CDEs), a program called "CPR for Diabetes Care." METHODS The program identified primary care physicians with optimal diabetes control rates below the system aggregate (n = 195). Physicians with the lowest rates (n = 74) were targeted for comprehensive intervention.

Contemporary issues in food allergy: seafood toxin-induced disease in the differential diagnosis of allergic reactions.

Seafood, including fish, shrimp, lobster, crab, crayfish, mussel, and clam are among the most frequent causes of food allergy. Seafood poisoning, including reactions to natural toxins, frequently masquerades as an allergic reaction on presentation. Ingestion of contaminated shellfish results in a wide variety of symptoms, depending on the toxins present, their concentrations in the shellfish, and the amount of contaminated shellfish consumed.

Sickle cell disease: health promotion and maintenance and the role of primary care nurse practitioners.

Purpose: To discuss the role of nurse practitioners (NPs) with regard to early identification of affected individuals, effective monitoring and screening, effective pain management and prophylaxis, and health education for patients with sickle cell disease (SCD).

Data Sources: Electronic database searches were performed using Medline, Cinahl, and PsycINFO. Data were obtained from medical textbooks, research, and review articles.

Adjustment, spirituality, and health in women on hemodialysis.

End stage renal disease (ESRD) is progressive, requiring adjustment. This descriptive correlational study examined levels of and relationships between adjustment, spiritual well-being, and self-perceived health in women with ESRD. The sample included 65 women aged 24 to 82 receiving hemodialysis at five outpatient centers in a large metropolitan area.