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University of Texas Medical Branch (UTMB) implemented the Clinical Competency and Advancement Program (CCAP) in January 2011. The program, built upon American Nurse Association (ANA) standards,1 is a professional development tool for competency assessment, performance evaluation, and career advancement for nurse clinicians from levels Nurse Clinician (NC) I to NC V. UTMB requires each nurse clinician to complete and submit CCAP program documents annually to the manager. In CCAP, nurse clinicians have required and elective (self-selected) criteria that must be demonstrated through performance, activity, or documentation. Nurses earn points, weighted by complexity, for accomplishments. Eligibility criteria and point requirements are progressively higher for each NC level, I to V. Elective criteria include a wide range of professional activities from which the nurse clinician may select, whereas required criteria reflect the expected nursing practice and performance for every nurse. Implementing CCAP meets the definition of "innovation" as a core group of nurse clinicians and leaders constructed, created, and implemented a totally new visionary process. CCAP reflects a stronger UTMB culture of professional practice and personal accountability, with an overarching outcome of higher levels of professional performance in patient care delivery. CCAP changes the way nurses view their practice. In June of 2012, UTMB submitted an initial CCAP article that was published in AONE's Nurse Leader.2

Background: The brain acoustic monitor (BAM), an indicator of cerebral autoregulation, has previously shown high sensitivity but low specificity for computed tomographic (CT) abnormality in patients following the clinical diagnosis of traumatic brain injury. We assessed the utility of the BAM in diagnosing mild TBI (mTBI) in patients with and without normal findings of CT scan, a population for which there are a few objective markers of disease. Methods: We prospectively studied 369 patients with mechanism of injury consistent with TBI. The diagnosis was evaluated by five methods: (a) study enrollment (i.e., mechanism of injury), (b) signs of head trauma, (c) expert physician assessment, (d) presence of initial symptoms (loss of consciousness [LOC]; amnesia), and (e) BAM. All patients had a head CT scan. We compared the BAM screen results with the diagnosis of mTBI and BAM data from 50 normal volunteers and 49 trauma control patients not thought to have TBI. Results: None of the diagnostic methods correlated well with the others. Correlation between the methods ranged from 21% to 71%. BAM discriminated between patients with mTBI versus without TBI (p < 0.01) and patients with mTBI versus normal subjects (p < 0.001). There were 14 patients with new abnormal findings of CT scans. A history of LOC and physical signs of head injury were associated with a new abnormality on head CT (p < 0.05 and p < 0.01, respectively), whereas an abnormal BAM signal was suggestive (p = 0.08). The sensitivity of BAM abnormality for head CT abnormality was 100%, with a specificity of 30.14%. Conclusion: There is no gold standard for the diagnosis of mTBI. BAM screening is a useful diagnostic adjunct in patients with mTBI and may facilitate decision making. An abnormal BAM reading adds significance to LOC as a predictor of a new abnormality on head CT. In our study, opting not to CT scan patients with a normal BAM signal would have missed no new CT findings and no patients who required medical intervention for TBI, at a cost savings of $202,950.

Medical pluralism can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. American women use a variety of health services and practices for women's health conditions, yet no national study has specifically characterized women's medical pluralism. Our objective was to describe medical pluralism among American women.A nationally representative telephone survey of 808 womenor=18 years of age was conducted in 2001. Cross-sectional observations of the use of 11 CAM domains and the use of an additional domain--spirituality, religion, or prayer for health--during the past year are reported. Women's health conditions, treatments used, reasons for use, and disclosure to conventional physicians are described, along with predictors of CAM use.Over half (53%) of respondents used CAM for health conditions, especially for those involving chronic pain. The majority of women disclosed such practices at clinical encounters with conventional providers. Biologically based CAM therapies, such as nutritional supplements and herbs, were commonly used with prescription and over-the-counter (OTC) pharmaceuticals for health conditions.Medical pluralism is common among women and should be accepted as a cultural norm. Although disclosure rates of CAM use to conventional providers were higher than in previous population-based studies, disclosure should be increased, especially for women who are pregnant and those with heart disease and cancer. The health risks and benefits of polypharmacy should be addressed at multiple levels of the public health system.

This study provides national prevalence estimates for complementary and alternative (CAM) use, visits to doctors for health problems, and the effects of acculturation on health practices in Chinese women living in the United States. A national telephone survey of 3,172 women on their use of complementary and alternative medicine was conducted in 2001. This study focuses on a subsample of 804 Chinese-American women who were asked about health practices and service utilization. Interviews were conducted in Mandarin, Cantonese and English. Forty-one percent of Chinese-American women used some form of CAM in 2001. Socio-economic status, a common predictor of CAM use in other studies of the general population in the United States, did not predict use in this sample. Traditional Chinese medicine (TCM) is used across acculturation levels. As Chinese women adapt to American culture they tend to use a greater variety of healthcare practices and to adopt mainstream CAM practices, but they also continue to use TCM.

This study documents the use of complementary and alternative medicine (CAM), among White, African American, and Hispanic/Latina women living in New York City. A pilot to a national survey of CAM use among American women, this study explores women's use of categories of CAM and various CAM practitioners, racial and ethnic differences in CAM use, and women's perceptions regarding the effectiveness of CAM. DESIGN AND LOCATION: Data were collected from women residing in New York City using random digit dialing/computer-assisted telephone interviewing (CATI). The sample of 300 had equal numbers of women (n = 100) who self-identified as White, Hispanic/Latina, and African American, equally stratified by age (below and above age 40).Eligibility requirements included self-identification as Anglo/white, African American, or Hispanic/Latina and between ages 18 and 80.Three distinct categories of CAM were explored: (1) medicinal teas, homeopathic remedies, herbs, vitamins; (2) yoga, meditation, spiritual practices; and (3) manual therapies including chiropractic, massage, acupressure. Health concerns of interest were those frequently described in prior focus groups, and included reproductive health issues (e.g., pregnancy, menstruation, menopause) as well as other common women's health problems (e.g., heart disease, high blood pressure, headaches).More than half the sample has used a CAM treatment or remedy, and 40% have visited a CAM practitioner. Among users, half have used only one of the CAM categories, approximately one third have used two, and 16% used all three. The category of CAM used most often was medicinal tea/herbs/vitamins; the practitioners visited most frequently were chiropractors (18%) and nutritionists (17%). Racial and ethnic differences in CAM use were minimal, and approximately one third of all treatments used were rated "very effective" by users.Substantial utilization of CAM remedies and treatments for a variety of women's health concerns is observed. Further inquiry with larger samples of women is recommended.