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Background: The call for nursing education reform has never been louder. National organizations recognize the urgent need to prepare nursing students to practice competently, moving away from traditional teaching and curricula and to competency-based education (CBE) strategies to prepare future nurses for independent clinical practice. Problem: The 2021 American Association of Colleges of Nursing Essentials do not account for the competencies achieved in registered nurse (RN) associate degree and diploma programs. This presents a challenge for RN to bachelor of science in nursing (BSN) program administrators and faculty when designing curricula to meet the new Essentials. Approach: The Essentials crosswalk created by the National RN-Baccalaureate Faculty Forum serves as a foundational guide for the development of the template models discussed in this article. Conclusion: This article provides a template of instructional models for implementing CBE in RN to BSN programs. [ABSTRACT FROM AUTHOR]

Melanoma skin cancer is the deadliest form of skin cancer, accounting for nearly 75% of all skin cancer deaths. A number of studies have examined potential relationships among melanoma incidence and outcomes and a range of demographic, socioeconomic, and other factors, with inconsistent results. This study examines incidence rates, stage at presentation, and cause-specific mortality for nodular and superficial spreading melanoma across the rural-urban continuum in Kentucky and considers the implications of findings with respect to disparities in healthcare access in rural areas. Objectives: This study compared incidence rates, stage at presentation, and cause-specific mortality of nodular and superficial spreading melanoma along the rural-urban continuum in Kentucky. We compared resulting patterns in our data with sample demographic and other potential factors, including population by county and primary care provider rate. Methods: Retrospective patient data were extracted from the Surveillance, Epidemiology, and End Results database from 2010 through 2017. These data were supplemented by environmental, demographic, and socioeconomic data derived from publicly accessible databases. Correlation and χ2 analyses were used to test for significant differences in outcome variables by US Department of Agriculture Rural-Urban Continuum Code (RUCC) categories and other potential predictor variables. Results: Incidence rates by Kentucky county were not associated with RUCC or population; likewise, there was no relationship between stage at presentation and RUCC category. There was, however, a highly significant association between cause-specific mortality and RUCC; patients from rural areas were significantly more likely to die from melanoma than those in urban areas. This overall difference was due to differences in mortality for superficial spreading melanoma. Conclusions: Our results suggest that a disparity in patients' ability or tendency to access primary care and/or specialist providers postdiagnosis may be critical factors in determining the ultimate outcome of a melanoma diagnosis. Further studies should explore the availability of dermatologists and/or treatment options for melanoma in rural areas. Our data also provide additional support for inclusion of melanoma subtype in the American Joint Committee on Cancer guidelines. [ABSTRACT FROM AUTHOR]

Objective: To characterize the current state of mental health within the surgical workforce in the United States. Background: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown. Methods: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed. Results: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95%CI: 1.04-3.65, P=0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P<0.001) or PTSD (aOR: 3.93, 95%CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months. Conclusions: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the racial and ethnic diversity of physician associate/assistant (PA) graduating cohorts during the profession's transition from a standard undergraduate degree to an entry-level master's degree. Methods: Using all existing program reports from the Physician Assistant Education Association (1985-2019), we explored potential associations between changes in tuition, degree types offered, and racial/ethnic makeup of graduating cohorts. Results: We observed a strong negative association between Black students and graduates versus increasing tuition and the rise of master's level programs. Conclusions: More equitable opportunities for joining the PA profession may be needed. [ABSTRACT FROM AUTHOR]

Background: Employment outcomes after liver transplant (LT) over the past decade have not been described. Methods: LT recipients ages 18-65 from 2010-2018 were identified in Organ Procurement and Transplantation Network data. Employment within two years post-transplant was assessed. Results: Of 35,340 LT recipients, 34.2% were employed post-LT, including 70.4% who were working pre-transplant, compared to only 18.2% not working preLT. Younger age, male sex, educational attainment, and functional status were associated with returning to employment. Conclusion: Returning to employment is an important goal for many LT candidates and recipients, and these findings can be used to guide their expectations. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral condition in children. Current guidelines recommend that Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) criteria be met before diagnosing ADHD. However, 14–49% of providers are not documenting the use of DSM-V criteria in screening and diagnosis. The use of a standardized electronic health record (EHR) ADHD template is a potential option to assist providers with documenting the DSM-V criteria. The aim for this project was to provide a 1-hour educational in-service on the use of the DSM-V criteria, Vanderbilt rating scale, and a revised EHR ADHD template, and to assess provider use pre and post intervention. Results showed that few providers (n = 1; 2%) document using DSM-V criteria preintervention and post intervention with only a modest increase in template use (n = 3; 5%). However, there were statistical differences between provider type with advanced practice registered nurses and physician assistants screening more frequently using the EHR DSM-V ADHD template compared with physicians (p =.009). Future studies are needed to evaluate barriers to use, including practice preference, openness to change, and other factors that may affect provider workflow. [ABSTRACT FROM AUTHOR]

Background: Traditional epidemiologic approaches such as time-series or case-crossover designs are often used to estimate the effects of extreme weather events but can be limited by unmeasured confounding. Quasi-experimental methods are a family of methods that leverage natural experiments to adjust for unmeasured confounding indirectly. The recently developed generalized synthetic control method that exploits the timing of an exposure is well suited to estimate the impact of acute environmental events on health outcomes. To demonstrate how this method can be used to study extreme weather events, we examined the impact of the 20-26 October 2007 Southern California wildfire storm on respiratory hospitalizations.Methods: We used generalized synthetic control to compare the average number of ZIP code-level respiratory hospitalizations during the wildfire storm between ZIP codes that were classified as exposed versus unexposed to wildfire smoke. We considered wildfire exposure eligibility for each ZIP code using fire perimeters and satellite-based smoke plume data. We retrieved respiratory hospitalization discharge data from the Office of Statewide Health Planning and Development. R code to implement the generalized synthetic control method is included for reproducibility.Results: The analysis included 172 exposed and 578 unexposed ZIP codes. We estimated that the average effect of the wildfire storm among the exposed ZIP codes was an 18% (95% confidence interval: 10% to 29%) increase in respiratory hospitalizations.Conclusions: We illustrate the use of generalized synthetic control to leverage natural experiments to quantify the health impacts of extreme weather events when traditional approaches are unavailable or limited by assumptions. [ABSTRACT FROM AUTHOR]

Objective: We sought to compare kidney transplantation outcomes between Veterans Affairs (VA) and non-VA transplant centers. Summary Background Data: Transplant care at the VA has previously been scrutinized due to geographic and systematic barriers. The recently instituted MISSION Act entered effect June 6th, 2019, which enables veteran access to surgical care at civilian hospitals if certain eligibility criteria are met. Methods: We evaluated observed-to-expected outcome ratios (O:E) for graft loss and mortality using the Scientific Registry of Transplant Recipients database for all kidney transplants during a 15-year period (July 1, 2001-June 30, 2016). Of 229,188 kidney transplants performed during the study period, 1508 were performed at VA centers (N = 7), 7750 at the respective academic institutions affiliated with these VA centers, and 227,680 at non-VA centers nationwide (N = 286). Results: Aggregate O:E ratios for mortality were lower in VA centers compared with non-VA centers at 1 month and 1 year (O:E = 0.27 vs 1.00, P = 0.03 and O:E = 0.62 vs 1.00, P = 0.03, respectively). Graft loss at 1 month and 1 year was similar between groups (O:E = 0.65 vs 1.00, P = 0.11 and O:E = 0.79 vs 1.00, P = 0.15, respectively). Ratios for mortality and graft loss were similar between VA centers and their respective academic affiliates. Additionally, a subgroup analysis for graft loss and mortality at 3 years (study period January 1, 2009-December 31, 2013) demonstrated no significant differences between VA centers, VA-affiliates, and all non-VA centers. Conclusions: Despite low clinical volume, VA centers offer excellent outcomes in kidney transplantation. Veteran referral to civilian hospitals should weigh the benefit of geographic convenience and patient preference with center outcomes. [ABSTRACT FROM AUTHOR]

The use of personal protective equipment (PPE) by nurses during the COVID-19 pandemic can be compared with a Christian's spritiual protective action of putting on the armor of God as described in the New Testament. The use and significance of each item of PPE is compared with the equivalent article of the spiritual armor of God. [ABSTRACT FROM AUTHOR]

The relationship of personality disorder (PD) psychopathology to the course of bipolar disorder remains inadequately described. After giving informed consent, more than 782 outpatients with bipolar disorder rated themselves on the 99-item Personality Disorder Questionnaire, Version 4 (PDQ4) when depressed or euthymic. They also rated six poor prognosis factors (PPFs). The relationships of the PPFs to the total PDQ4 score were examined by a linear regression. Even after correcting for the higher PDQ4 scores observed when patients were suffering depression, the PDQ4 was significantly related to a history of child abuse, early age of onset, an anxiety disorder comorbidity, rapid cycling, and 20 or more previous episodes, but not substance abuse. The data suggest close relationships between the total burden of PD psychopathology and correlates of an adverse outcome of bipolar disorder. The nature of this of association and approaches to treatment of comorbid PD remain to be further explored. [ABSTRACT FROM AUTHOR]

This study evaluated a tool to identify patients who are imminently dying to prevent the transfer of these patients during the dying process. The End-of-Life Transfer Tool was developed by the investigators based on themes from the literature and experiences of palliative care experts. The final checklist contained 6 objective assessment elements. Thirty patients seen by the palliative care team during a 10-month period were included in the study conducted in a Midwestern teaching hospital. An inversely, statistically significant correlation was found on the total score as assessed by the palliative care nurses and the actual time of death, indicating a relationship between the score on the tool and the time to death. This pilot work serves as the beginning research toward the development of a brief tool to support the decision-making of the bedside nurse. [ABSTRACT FROM AUTHOR]

The profound impact of the human microbiome on health makes it imperative that nurses understand the basic structures and functions of the various microbial communities. In studying the human microbiome, advances in DNA and RNA sequencing technology offer benefits over traditional culture-based methods. Such technology has permitted more thorough investigations of microbial communities, particularly those of the gastrointestinal (GI) and female reproductive tracts. Although individual variations exist, each site exhibits distinct compositions. The diverse GI microbiota aid in digestion, mood regulation, and vitamin synthesis. While many factors affect the composition and functions of the GI microbiota, diet likely exerts the strongest influence. Vaginal microbiota tend to be less diverse, and mainly serve to protect women from infection. The composition of the vaginal microbiota is influenced by sexual activity, hygienic practices, medications, smoking, and other factors. Our increasing knowledge about the structures and functions of the GI and vaginal microbiota allows nurses to provide targeted, evidence-based education and care for various populations. [ABSTRACT FROM AUTHOR]

Nursing executives are continually challenged to address a rapidly evolving health care system. Every aspect of care delivery is being scrutinized, yet the constant requirement remains assurance of high-quality, highly reliable care that is cost-effective and easily accessible. The nursing workforce remains visible in traditional roles as well as in new and innovative capacities, whereas nurse executives experience expanded realms of focus and responsibility. As health systems continue to adapt to the changing environment, the ability to leverage the role and scope of the advanced practice registered nurse (APRN) as a health care provider is emerging as an essential business and care strategy. While the APRN role is more commonly accepted in primary care, ambiguity persists in how to best use the role along the continuum of care to achieve the cost-effective solutions required in today’s health care environment. Successful health care systems of today and tomorrow are those that act boldly in a strategic direction. Data-driven decision making is key to meaningful change, whether clinical or operational. The need to develop high-functioning, integrated provider teams is apparent and immediate. Nurse executives and their nursing leadership colleagues must lead with evidence in hand to create infrastructures that support true integration, optimization, and engagement of all members of the provider team to better serve our patients and communities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to use fault tree analysis to evaluate the adequacy of quality reporting programs in identifying root causes of postoperative bloodstream infection (BSI). A systematic review of the literature was used to construct a fault tree to evaluate 3 postoperative BSI reporting programs: National Surgical Quality Improvement Program (NSQIP), Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (JC). The literature review revealed 699 eligible publications, 90 of which were used to create the fault tree containing 105 faults. A total of 14 identified faults are currently mandated for reporting to NSQIP, 5 to CMS, and 3 to JC; 2 or more programs require 4 identified faults. The fault tree identifies numerous contributing faults to postoperative BSI and reveals substantial variation in the requirements and ability of national quality data reporting programs to capture these potential faults. Efforts to prevent postoperative BSI require more comprehensive data collection to identify the root causes and develop high-reliability improvement strategies. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis of patients with spinal muscular atrophy (SMA) treated with growing rod (GR) instrumentation for scoliosis. Objective: To evaluate structural effectiveness, complications, and length of hospital stay associated with GRs for scoliosis in SMA and to compare values with those of infantile and juvenile idiopathic scoliosis (IIS/JIS). Summary Of Background Data: Most studies evaluate GR effectiveness in all patients. We specifically examined SMA and IIS/JIS. Methods: We searched a multicenter database and found 15 patients with SMA and scoliosis treated with GRs for 54 ± 33 months. Radiographic measurements, complications, and hospital stay durations were compared with those of 80 GR patients with IIS/JIS observed for 43 ± 31 months. Measures of rib collapse, including T6:T10 mean rib-vertebral angle and T6:T12 thoracic width, were compared. Student t test was used to compare SMA and IIS/JIS values (significance level, P = 0.05). Results: Primary radiographic measurements in patients with SMA improved from preoperative to latest follow-up as follows: curve, 89° ± 19° to 55° ± 17°; pelvic obliquity, 31° ± 14° to 11° ± 10°; space-available-for-lung ratio, 0.86 ± 0.15 to 0.94 ± 0.21; and T1-S1 length grew 8.7 ± 3.2 cm. Rib collapse continued despite GR treatment in SMA but not in IIS/JIS. Hospital stays were longer for SMA than for IIS/JIS for lengthening procedures (P = 0.01) and trended to be longer for initial surgery (P = 0.08) and final fusion (P = 0.06). Patients with SMA and IIS/JIS experienced, respectively, 0.5 and 1.1 major complications per patient (P = 0.02). Conclusion: GRs improve trunk height and the space-available-for-lung ratio while controlling curve and pelvic obliquity in young patients with SMA with severe scoliosis, but they do not halt rib collapse. For patients with SMA, hospital stays were longer than those for patients with IIS/JIS, whereas the rate of major complications was lower. [ABSTRACT FROM AUTHOR]