A Visionary Think Tank to Address the Nursing Workforce Crisis.

The COVID-19 pandemic exacerbated an existing problem plaguing hospital systems across the United States: a nursing workforce shortage. This article describes how one institution applied the American Organization for Nursing Leadership Nurse Executive Competencies to convene an immersive think tank to reimagine the nursing workforce.

An Educational Intervention to Improve Patient Outcomes for Colonoscopy.

Bowel prep for inpatient cases are for the most part inadequate. Gastroenterology nurses are ideally situated to recognize the importance of bowel preparation for patients who require a colonoscopy. Unique challenges exist for inpatients who require a colonoscopy preparation as part of their hospitalization.

Cost Effectiveness of Allogeneic Umbilical Cord Blood-Derived Mesenchymal Stem Cells in Patients with Knee Osteoarthritis.

Objectives: The aim of this study was to assess the cost effectiveness of allogeneic umbilical cord blood-derived mesenchymal stem cells with sodium hyaluronate (hUCB-MSC) compared with microfracture in patients with knee cartilage defects caused by osteoarthritis (OA) in South Korea.

Methods: A partitioned survival model approach was taken consisting of five mutually exclusive health states: excellent, good, fair, poor, and death over a 20-year time horizon. Utility values were obtained from a randomized clinical trial.

Risk Assessment of the Door-In-Door-Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers.

Background Patients with acute stroke at non- or primary stroke centers (PSCs) are transferred to comprehensive stroke centers for advanced treatments that reduce disability but experience significant delays in treatment and increased adjusted mortality. This study reports the results of a proactive, systematic, risk assessment of the door-in-door-out process and its application to solution design. Methods and Results A learning collaborative (clinicians, patients, and caregivers) at 2 PSCs and 3 comprehensive stroke centers in Chicago, Illinois participated in a failure modes, effects, and criticality analysis to identify steps in the process; failures of each step, underlying causes; and to characterize each failure's frequency, impact, and safeguards using standardized scores to calculate risk priority and criticality numbers for ranking.

Ulcerative cutaneous sarcoidosis successfully treated with infliximab.

Sarcoidosis is a systemic inflammatory disorder with cutaneous involvement present in 25% of cases. We present a patient with ulcerative sarcoidosis to highlight this unusual presentation of a relatively rare cutaneous condition that was treated successfully using infliximab. The drug is effective in cutaneous sarcoidosis, but relapses can occur after discontinuation.

Leveraging Professional Governance During the COVID-19 Pandemic.

Dynamic nursing leadership and engagement of nursing at all levels are critical to effective care delivery. During the COVID-19 crisis, many organizations suspended non-COVID-related meetings, including professional governance councils where practice decisions are made. This article highlights how shared or professional governance was leveraged during this global pandemic at a large academic medical center and community hospital effectively sustaining autonomous nursing practice while responding to a rapidly changing environment and impacting quality patient care.

Integrating the Social Determinants of Health into Nursing Practice: Nurses' Perspectives.

Purpose: The purpose of this study was to assess nurses' knowledge, perceived self-efficacy, and intended behaviors relative to integrating the social determinants of health (SDoH) into clinical practice.

Design And Methods: A cross-sectional study was completed with 768 nurses working in three hospitals within a large regional healthcare system located in the Midwest. Data were collected using an adapted 71-item SDoH Survey, which measured nurses' confidence in and frequency of discussing the SDoH with patients, general knowledge of the SDoH, familiarity with patients' social and economic conditions, and awareness of their institution's health equity strategic plan to achieve health equity.

Development of the PC-7, a Quantifiable Assessment of Spiritual Concerns of Patients Receiving Palliative Care Near the End of Life.

Attending to the religious/spiritual (R/S) concerns of patients is a core component of palliative care. A primary responsibility of the chaplain is to conduct a thorough assessment of palliative care patients' R/S needs and resources. Problems with current approaches to spiritual assessment in all clinical contexts, including palliative care, include limited evidence for their validity, reliability, or clinical usefulness; narrative content; and lack of clinical specificity.

Distal Femoral Osteotomy and Lateral Meniscus Allograft Transplant.

Distal femoral varus-producing osteotomy can be performed in the setting of lateral meniscal transplant to correct valgus malalignment of the knee and thus offload the lateral compartment. Advantages of a lateral opening wedge over medial closing wedge osteotomy include a single bone cut, avoidance of vascular structures, and theoretically better control of the amount of correction. It is important to address all knee joint comorbidities, including meniscal deficiency, chondral and osteochondral defects, and ligamentous insufficiency.

Rock-Hard Chronic Thrombotic Occlusion and Its Management in Endovascular Interventions.

Endovascular recanalization for patient with peripheral arterial disease and the end of its spectrum critical limb ischemia (CLI) has become a preferred method of revascularization due to advancement of techniques and equipment, allowing reduction of limb amputations while maintaining a minimally invasive approach compared to surgical approaches. Interventionalists have undertaken a progressively increasing complexity of diseased vessels in the hopes of providing inline unobstructed flow through occlusions for patients with claudication as well as direct flow to a nonhealing wound in patients with CLI. One of the major roadblocks encountered in lower extremity recanalization procedures is managing severely calcified chronic thrombotic occlusions which decrease luminal revascularization, ultimately increasing use of adjunctive interventions such as subintimal tracking, reentry device utilization, and stent placement.

Emergent Complications of Rheumatoid Arthritis.

Background: Rheumatoid arthritis (RA) is an autoimmune disease resulting in polyarthritis and systemic effects that may result in morbidity and mortality.

Objective: This review provides the emergency physician with an updated analysis of acute complications seen with RA, as well as an evidence-based approach to the management of these complications.

Discussion: While the joint characteristics of RA are commonly recognized, the extra-articular manifestations may be overlooked.

New hairworm (Nematomorpha, Gordiida) species described from the Arizona Madrean Sky Islands.

Gordiids, or freshwater hairworms, are members of the phylum Nematomorpha that use terrestrial definitive hosts (arthropods) and live as adults in rivers, lakes, or streams. The genus consists of 18 species, one of which was described from the Nearctic in 1851. More than 150 years later, we are describing a second species from a unique habitat within the Nearctic; the Madrean Sky Island complex.

Using Chaplains to Facilitate Advance Care Planning in Medical Practice.

This quality improvement study examines the effectiveness of having a board-certified chaplain conduct advance care planning conversations and end of life preferences with patients at the time of a routine office visit with a physician.

Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis.

Background: The use of platelet-rich plasma (PRP) for the treatment of osteoarthritis (OA) has demonstrated mixed clinical outcomes in randomized controlled trials when compared with hyaluronic acid (HA), an accepted nonsurgical treatment for symptomatic OA. Biological analysis of PRP has demonstrated an anti-inflammatory effect on the intra-articular environment.

Purpose: To compare the clinical and biological effects of an intra-articular injection of PRP with those of an intra-articular injection of HA in patients with mild to moderate knee OA.

Recall and Cancer Detection Rates for Screening Mammography: Finding the Sweet Spot.

Objective: The purpose of this study is to identify the optimal screening mammography recall rate range on the basis of cancer detection rates among breast imaging specialists at an academic institution.

Materials And Methods: Medical outcome audit data collected in accordance with the Mammography Quality Standards Act from September 1, 2007, through August 31, 2012, were reviewed. Cancer detection rates were calculated from 984 screen-detected cancers identified in 188,959 total digital screening mammograms.

Oncology Nursing and Shared Decision Making for Cancer Treatment.

This study aimed to describe the contemporary role of the oncology nurse throughout the entire cancer shared decision-making (SDM) process. Study participants consisted of 30 nurses and nurse practitioners who are actively involved in direct care of patients with cancer in the inpatient or outpatient setting. The major themes that emerged from the content analysis are: oncology nurses have various roles at different time points and settings of cancer SDM processes; patient education, advocacy, and treatment side effects management are among the top nursing roles; oncology nurses value their participation in the cancer SDM process; oncology nurses believe they have a voice, but with various degrees of influence in actual treatment decisions; nurses' level of disease knowledge influences the degree of participation in cancer SDM; and the nursing role during cancer SDM can be complicated and requires flexibility.

Philanthropy as a source of funding for nursing initiatives.

Nurse leaders are challenged with ensuring that research and evidence-based practices are being integrated into clinical care. Initiatives such as the Magnet Recognition Program have helped reinforce the importance of advancing nursing practices to integrate best practices, conduct quality improvement initiatives, improve performance metrics, and involve bedside nurses in conducting research and evidence-based practice projects. While seeking research funding is an option for some initiatives, other strategies such as seeking funding from grateful patients or from philanthropic resources are becoming important options for nurse leaders to pursue, as the availability of funding from traditional sources such as professional organizations or federal funding becomes more limited.

Visioning as a hiring strategy for quality outcomes.

Mutual trust and shared nurse leadership behaviors between the chief nurse executive and nursing staff are linked to improved clinical outcomes through an initial visioning process. The authors outline a hospital's strategy to improve nurse-driven outcomes by using visioning in the hiring process. Visioning, implemented in the hiring process, is a unique application of this tool for creating a desired future.

Handoff communication: using failure modes and effects analysis to improve the transition in care process.

Handoff communication is a high-risk process that causes errors that lead to ineffective care delivery and patient safety breaches. A failure modes and effects analysis was utilized to proactively evaluate handoff through a risk priority scoring process that focused the improvement plan on communication from shift to shift and between units. The electronic medical record was utilized to standardize the handoff tool in SBAR (situation, background, assessment, and recommendation) format for both nurses and patient care technicians.