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Cardiovascular implantable electronic device infection (CIEDI) rates are rising. To improve outcomes, our institution developed an online care process model (CPM) and a specialized inpatient heart rhythm service (HRS). This retrospective review compared hospital length of stay (LOS), mortality, and times to subspecialty consultation and procedures before and after CPM and HRS availability. CPM use was associated with shortened time to surgical consultation (median 2 days post-CPM vs. 3 days pre-CPM, p = 0.0152), pocket closure (median 4 vs. 5 days, p

Purpose Over a third of critical illness survivors manifest significant psychocognitive impairments following discharge from the intensive care unit (ICU). It is not known which patient populations are at highest risk or if assessment at ICU discharge can guide outpatient treatment prioritization. Materials and methods Prospective single center study in an academic medical center encompassing six types of ICUs assessed prevalence of psychocognitive morbidity based on ICU type and associations between initial and 3 month follow-up evaluation. Adult patients with >48 h ICU stays completed the Hospital Anxiety and Depression Scale (HADS), Impact of Events Scale-Revised (IES-R), and Montreal Cognitive Assessment-Blind (MoCA-blind). Results Of 299 patients who underwent initial assessment, 174 (58%) completed follow-up. Length of stay, MoCA-Blind, HADS-A/D and IES-R scores were similar across ICUs. Most commonly observed impairment in-hospital was cognitive (58%) followed by anxiety (45%), acute stress (39%) and depression (37%). There were significant correlations between in-hospital and follow-up psychocognitive outcomes. Conclusions There was no significant difference in impairment by ICU type. Significant correlation between the initial assessment and follow-up scores suggests that early screening of high risk patients may identify those at greatest risk of sustained morbidity and facilitate timely intervention.

Physical assessment is an important component of professional nursing practice. New nurse graduates experience difficulty transitioning the traditional head to toe physical assessment into real world nursing practice. This study was conducted to provide current data concerning physical assessment competencies utilized consistently by registered nurses. This quantitative study used a 126 item survey mailed to 900 Registered Nurses. Participants used a Likert-type scale to report frequency of use for physical assessment competencies. Thirty seven competencies were determined to be essential components of the physical assessment, 18 were determined supplemental, and 71 were determined to be non-essential. Transition of the new graduate nurse into professional practice can be enhanced by focusing content in physical assessment practicum courses on the essential competencies of physical assessment. Faculty for the university has analyzed data from this study to support evidence based changes to the undergraduate nursing program physical assessment practicum course.

Numerous studies in the audit judgment literature provide evidence indicating that auditors can be susceptible to recency effects. This study extends the research by examining auditor susceptibility to primacy, an order effect, which, like recency, can lead to suboptimal audit-planning decisions (see Ashton and Ashton 1988) and yet, unlike recency, has received very little attention in the accounting literature. Specifically, the research investigates whether primacy effects in auditor belief revisions are a conditional function of the level of inherent risk present in the audit environment (high/low) and the nature of the information contained in the latter portion of the information sequence (e.g., whether the information is positive or negative with respect to the client's internal controls). The results, consistent with expectations, indicate that auditors are susceptible to primacy effects when making likelihood of error and audit-hour planning judgments in settings that are relatively low in inherent risk, and such effects are due to less integration of late positive information in low- as compared to high-risk conditions. No evidence of primacy was found for either judgment when the inherent risk associated with the audit setting was high and, auditors did not differentially revise their beliefs across inherent risk conditions for late negative information. The findings indicate that primacy is essentially the result of insufficient integration of late positive information in low inherent risk settings, suggesting that primacy may lead to overauditing and thus, an inefficient use of audit resources.

A vital concern to the international auditing community is the litigation risk created by the ‘expectations gap’, the existence of potential differences between societal views of the scope of auditor responsibility and those of audit professionals. The focus of this study is to investigate the role that factors identified as important in professional audit standards and in the international press play in attributions of auditor responsibility in two important audit contexts: fraud and going concern. With respect to fraud detectability, the factors investigated were collusion and materiality, while those factors related to going concern predictability were evidence reliability and timing of unpredicted events. US auditors and practicing judges participated in the study. Consistent with expectations, the results indicate that auditors' attributions of responsibility were significantly affected by the detectability and predictability variables examined. The effect of the factors on judges' attributions of auditor responsibility was moderated by their general attitudes toward the auditing profession. Specifically, in the absence of mitigating factors, judges with unfavorable attitudes made greater responsibility assessments than those with favorable attitudes. However, in the presence of mitigating factors such as collusion or when the time period between the audit opinion date and bankruptcy was long, judges with unfavorable attitudes made significantly lower responsibility assessments. Lastly, while evidence reliability and materiality significantly affected auditors' attributions, they did not play a role in the attributions of the judges.

A vital concern to the international auditing community is the litigation risk created by the ‘expectations gap’, the existence of potential differences between societal views of the scope of auditor responsibility and those of audit professionals. The focus of this study is to investigate the role that factors identified as important in professional audit standards and in the international press play in attributions of auditor responsibility in two important audit contexts: fraud and going concern. With respect to fraud detectability, the factors investigated were collusion and materiality, while those factors related to going concern predictability were evidence reliability and timing of unpredicted events. US auditors and practicing judges participated in the study. Consistent with expectations, the results indicate that auditors' attributions of responsibility were significantly affected by the detectability and predictability variables examined. The effect of the factors on judges' attributions of auditor responsibility was moderated by their general attitudes toward the auditing profession. Specifically, in the absence of mitigating factors, judges with unfavorable attitudes made greater responsibility assessments than those with favorable attitudes. However, in the presence of mitigating factors such as collusion or when the time period between the audit opinion date and bankruptcy was long, judges with unfavorable attitudes made significantly lower responsibility assessments. Lastly, while evidence reliability and materiality significantly affected auditors' attributions, they did not play a role in the attributions of the judges.

Many patients refuse blood or blood products because of religious beliefs or fear of complications. At Hennepin County Medical Center, a multidisciplinary team developed a Bloodless Surgery Medicine Guideline (BSMG) to help identify those who refuse blood products, guide medical decision-making, improve documentation of informed consent or refusal, and ensure continuity of care for patients. To our knowledge, this is the first documentation of a guideline for managing informed consent for or refusal of blood or blood products in trauma patients. This article discusses the development of and legal rationale for two key components of the BSMG: an informed consent/refusal algorithm and a blueprint for discussing the use of blood or blood components with patients and documenting their decisions.

Most undergraduate and graduate financial accounting exercises follow a “forward based” pedagogical approach where students learn how accounting events (causes) are captured in the accounting system and appear on the financial statements (effects). While these forward based approaches are necessary and effective ways to teach the fundamentals of accounting, they provide a relatively narrow procedural perspective on how to use such knowledge. The reality is that many students will be required to solve problems where the ultimate goal is to discern the causes of financial statement outcomes. To solve such problems, “backward based” procedural knowledge is required. Research in cognitive psychology indicates students need exposure to problems that require different procedural knowledge to develop the flexible problem solving schemas necessary to address problems with different end goals (Chen & Mo, 2004). We present a series of financial accounting exercises designed to help students develop skills associated with analyzing financial statement outcomes (effects) to determine the causal accounting events. The exercises also provide a comprehensive review of the primary financial accounting topics typically addressed in introductory accounting courses. This allows the exercises to be used as an ongoing end of chapter review problem or as a comprehensive course review exercise.

• Objective. —Eight asymptomatic patients with sickle-cell disease (SCD) with magnetic resonance imaging (MRI) abnormalities consistent with cerebral infarcts (group 1) and eight asymptomatic patients with SCD with normal MRI scans (group 2) were followed up to assess the neurological correlates and the clinical outcome. Design. —Patients in the two cohorts underwent clinical evaluations and xenon 133 regional cerebral blood flow (rCBF) studies within 1 month of the entry MRI. This study sequence was repeated up to 5 years later. Neuropsychological studies also were performed in six group 1 patients and eight group 2 patients at the end of the study. Setting. —The patients were recruited from the Comprehensive Sickle Cell Center at Columbia University, New York, NY. Patients. —All patients had SCD, hemoglobin SS, and normal findings on clinical evaluation at entry. The group 1 cohort had clinically silent MRI abnormalities consistent with cerebral infarction. The group 2 cohort was age matched to group 1 and had normal MRI studies. Interventions. —None. Main Outcome Measure. —The natural history of MRI abnormalities and the neurological correlates were assessed to determine the predictive value of subclinical MRI lesions as a risk factor for clinically apparent stroke. Results. —The mean duration of MRI follow-up was 3.7 years. In group 1, four patients (50%) demonstrated progressive MRI abnormalities and three patients (38%) became clinically symptomatic. In group 2, findings for all patients remained normal on clinical and radiological examination. Both groups had markedly elevated rCBF values. Individual rCBF differences correlated with the specific MRI abnormalities. The psychometric study results were similar in the two cohorts. Eighty-three percent of group 1 and 88% of group 2 patients had defective scores in one or more areas of cognitive functioning. Three patients met cognitive criteria for dementia. Conclusions. —Cranial MRI abnormalities have important prognostic implications even when detected in clinically asymptomatic patients. Cognitive abnormalities exist in patients with SCD even in the absence of MRI abnormalities or clinical stroke.