Volatility and Persistence of Value-Based Purchasing Adjustments: A Challenge to Integrating Population Health and Community Benefit Into Business Operations.

With the passage of the Deficit Reduction Act of 2005 and the Patient Protection and Affordable Care Act in 2010, Medicare's Inpatient Prospective Payment System (IPPS) began a transition to value-based purchasing (VBP) that rewards or penalizes hospitals based on patient satisfaction, clinical processes of care, outcomes, and efficiency metrics. However, hospital-level volatility vs. persistence in value-based payments year-over-year could result in unpredictable cash flows that negatively influence investment behavior, drive underinvestment in community benefit/population health management initiatives, and make management of the factors that drive the VBP adjustment more challenging.

Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity.

Objective: To determine the effect of 2 standard methods (i.e., twill tape versus adhesive tape) of securement on unplanned extubation, oral mucosa, and facial skin integrity of the orally intubated patient.

AANA Journal Course: update for nurse anesthetists--femoral nerve block and 3-in-1 block in anesthesia.

Femoral nerve blocks and 3-in-1 blocks are simple and useful alternatives to other regional or general anesthetic techniques for selected surgeries. These blocks also may provide postoperative analgesia that may be a useful alternative to epidural or parenteral analgesia. Understanding the techniques of blockade, its appropriate applications, and the relevant anatomy may provide the anesthetist with a valuable alternative.

Forensic science program: a community effort.

A forensic science program has been developed to assist the professional community population in using a scientific approach in the investigation of criminal offenses. The science of medicine and the principles of the law come together to form a multidisciplinary group of professionals to instruct in the collection of evidence after a crime has been committed. Specialists in these areas include forensic pathologists, forensic anthropologists, forensic odontologists, entomologists, and a radiologist with a specialty in forensics.

Clinical correlation map. A tool for linking theory and practice.

To facilitate application of theoretical knowledge to clinical practice, students develop a clinical correlation map that diagrams the relationships between each client's assessment and diagnostic data, medical treatment, human responses, and nursing diagnoses. In addition to the tool's benefits to the student, faculty can quickly assess the student's understanding of pathophysiology, diagnostic testing, treatment, nursing diagnoses, and interventions.

Utilizing an outcomes approach to improve pain management by nurses: a pilot study.

Effective pain management is a major challenge for nurses. The literature indicates that patients' pain continues to be inconsistently and ineffectively managed. The purpose of the pilot study was to measure the effectiveness of a structured intervention to improve pain management for patients.

Percutaneous extraction of a fractured, exposed atrial "J" lead retention wire.

The recent identification of fracturing of the retention wire in the Telectronics atrial lead, models 329-701 and 330-801, and the report of death due to cardiac tamponade caused by aortic puncture resulting from protrusion of the retention wire, necessitates fluoroscopic screening of these patients and the explantation of all leads identified to have the component failure. We present in this paper a percutaneous alternative to lead explantation in patients with protrusion of the retention wire through the polyurethane insulation and with an otherwise properly functioning atrial lead.

The effects of music interventions on anxiety in the patient after coronary artery bypass grafting.

Objective: To examine the influence during the early postoperative period of selected nursing interventions on mood and anxiety of patients undergoing heart surgery.

Design: Prospective, repeated measures, quasiexperimental, random assignment.

Setting: The cardiovascular intensive care and progressive care units of a midwestern community hospital were used as the setting for this study.

A comparison of patient teaching outcomes among postoperative coronary artery bypass graft (CABG) patients.

Shortened hospitalizations following cardiac surgery necessitate re-evaluation of how pertinent information for self-care management and reduction of coronary artery disease risk factors can be incorporated into an effective inpatient cardiac patient teaching program. This study investigated the effect of three different teaching approaches (i.e.

Oncology clinical nurse specialists' perceptions of their influence on patient outcomes.

Purpose/objectives: To measure and compare oncology clinical nurse specialists' (OCNSs) perceptions of patient outcomes influenced through their practice and barriers to outcome production.

Design: Descriptive survey.

Setting: National.

Stress and coping in families of children with myelomeningocele.

This pilot study examined differences in and relationships between parent health-related stressors (child care needs and parental concerns), daily hassles, and coping strategies of 17 mothers and 17 fathers of preschool and school-age children with myelomeningocele (MMC). Help related to play was the most frequent need among mothers; fathers needed the most help with school activities. Among the greatest concerns of both parents were their child's future and sufficient income.

Cardiac transplantation--first year experience in a community hospital: a three year follow-up.

This is a report of ten consecutive patients with end-stage cardiac disease treated with orthotopic cardiac transplantation in a community hospital, during the first year of its heart transplantation program. All patients were followed for a minimum of 33 months and a maximum of 45 months with 100% survival at two years and 90% at three years. All survivors are presently in N.

Two episodes of cytomegalovirus-associated colon perforation after heart transplantation with successful result.

A patient with end-stage heart disease was discharged from the hospital on postoperative day 7 after orthotopic heart transplantation. Three weeks from the day of operation, he developed sigmoid colon perforation, which required Hartmann's procedure, and 2 weeks later he had cecal disruption. A pathologic specimen showed underlying diverticular disease with associated cytomegalovirus colitis.

Unusual symptom in patient with pseudoaneurysm of the left ventricle and review of the literature.

A case of pseudoaneurysm developing 2 years after left ventricular aneurysmectomy and single coronary artery bypass graft is reported. A hypothesis that pseudoaneurysms developing after transmyocardial incision begin in surgery or shortly thereafter is postulated. Chest X-ray films as a preliminary test to direct attention to the diagnosis are recommended.